Provider Demographics
NPI:1962758342
Name:SHANDS LAKE SHORE REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:SHANDS LAKE SHORE REGIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARROD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:386-292-8120
Mailing Address - Street 1:8947 ABBINGTON DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32534-5347
Mailing Address - Country:US
Mailing Address - Phone:843-860-0005
Mailing Address - Fax:
Practice Address - Street 1:368 NE FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-3088
Practice Address - Country:US
Practice Address - Phone:386-292-8120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME112455282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren