Active NPI
Shands at Lake Shore Inc
- Pharmacy
- Lake City, FL
National Provider Identifier
1366538175
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- 4258
- Legal business name
- SHANDS AT LAKE SHORE INC
- Practice address
- 368 NE Franklin St
Lake City, FL 32055-3088 - Phone
- (386) 754-8000
- Fax
- (352) 733-0069
- NPI assigned
- Oct 5, 2006
- Last updated
- Nov 20, 2007
- Organization subpart
- Yes
- Parent organization
- SHANDS AT LAKE SHORE INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Jodi Mansfield
- Title
- Sr. Vice President & Coo
- Phone
- (352) 265-0440
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | 4258 | FL | Primary |
Addresses
Primary practice location
368 NE Franklin St
Lake City, FL 32055-3088
Mailing address
720 SW 2ND Ave
Suite 360C
Gainesville, FL 32601-6271
Phone (352) 733-0060
Other names 1
- Shands Lake Shore Durable Medical Equipment
National Provider Directory
National Provider Directory- Tax ID family
- Wallace Owens Crna
- Part of
- Wallace Owens Crna
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Shands Lake Shore Regional Medical Center
- General Acute Care Hospital
- Lake City, FL
- NPI 1386743045
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160006400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1195516800000",
"number": "1366538175",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "720 SW 2ND AVE",
"address_2": "SUITE 360C",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326016271",
"telephone_number": "352-733-0060",
"fax_number": "352-733-0069"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "368 NE FRANKLIN ST",
"city": "LAKE CITY",
"state": "FL",
"postal_code": "320553088",
"telephone_number": "386-754-8000",
"fax_number": "352-733-0069"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SHANDS AT LAKE SHORE INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "SHANDS AT LAKE SHORE INC",
"enumeration_date": "2006-10-05",
"last_updated": "2007-11-20",
"status": "A",
"authorized_official_last_name": "MANSFIELD",
"authorized_official_first_name": "JODI",
"authorized_official_title_or_position": "SR. VICE PRESIDENT & COO",
"authorized_official_telephone_number": "352-265-0440",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "FL",
"license": "4258",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Shands Lake Shore Durable Medical Equipment",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Lake City, FL
- Pramila Anjaneya Setty, MD
- Kayla Severance, DPT
- SF Brevard, LLC (The Rehabilitation Center of Lake City)
- Brian Sganga, PTA
- Britany Kay Shaheen
- Shands at Lake Shore Inc (Lake Shore Orthopedic Specialists)
- Shands at Lake Shore Inc (Lake Shore Specialty Group)
- Shands at Lake Shore Inc (Shands Surgical Specialists of Lake City)
- Shands Lake Shore Regional Medical Center
- Katelyn Shannon, LMT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.