NPIMap

Organization Active NPI

Shands at Lake Shore Inc

Doing business as Lake Shore Orthopedic Specialists

  • Clinic/Center
  • Lake City, FL
National Provider Identifier
1497854186
Registry record updated May 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
SHANDS AT LAKE SHORE INC
Doing business as
Lake Shore Orthopedic Specialists
Practice address
348 NE Methodist Ter
Suite 101
Lake City, FL 32055-3409
Phone
(386) 755-4007
Fax
(352) 733-0069
NPI assigned
Sep 21, 2006
Last updated
May 7, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
SHANDS AT LAKE SHORE INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 7, 2008

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary
Multi-Specialty Clinic/Center 261QM1300X NU

Addresses

Primary practice location

348 NE Methodist Ter
Suite 101
Lake City, FL 32055-3409

Mailing address

720 SW 2ND Ave
Suite 360C
Gainesville, FL 32601-6271
Phone (352) 733-0060

Other identifiers 2

IdentifierTypeStateIssuer
264258102MedicaidFL
CK8077OtherFLMEDICARE RR

Other names 1

  • Lake Shore Orthopedic Specialists Doing business as

National Provider Directory

National Provider Directory
Part of
Shands at Lake Shore Inc

Locations

368 NE Franklin St
Fl 2
Lake City, FL 32055
Phone (386) 754-8000

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210118400000",
    "number": "1497854186",
    "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": "348 NE METHODIST TER",
            "address_2": "SUITE 101",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320553409",
            "telephone_number": "386-755-4007",
            "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": "2006-09-21",
        "last_updated": "2008-05-07",
        "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": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "264258102",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "CK8077",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Shore Orthopedic Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake City, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.