Shands at Lake Shore Inc

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

SHANDS AT LAKE SHORE INC

Doing business as

Shands Surgical Specialists of Lake City

Practice address

755 SW State Road 47
Lake City, FL 32025-0453

Phone

(386) 755-7788

Fax

(352) 733-0069

NPI assigned

Sep 21, 2006

Organization subpart

Yes

Parent organization

SHANDS AT LAKE SHORE INCAs reported in NPPES

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

Addresses

Other identifiers 2

Other names 1

• Shands Surgical Specialists of Lake City Doing business as

Part of

Radiation Therapy Gainv

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Shands Teaching Hospital and Clinics Inc

  dba UF Health Medical Specialties Davis Cancer Pavilion

  • General Acute Care Hospital
  • Gainesville, FL
  • NPI 1083403661

  Member Of

  NPD member

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": "1871692475",
    "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": "755 SW STATE ROAD 47",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320250453",
            "telephone_number": "386-755-7788",
            "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": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "CK8077",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "264258101",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shands Surgical Specialists of Lake City",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brian Sganga, PTA
• Britany Kay Shaheen
• Shands at Lake Shore Inc
• Shands at Lake Shore Inc (Lake Shore Orthopedic Specialists)
• Shands at Lake Shore Inc (Lake Shore Specialty Group)
• Shands Lake Shore Regional Medical Center
• Sharing N Caring Medical Transport
• Lewis Mitchell Sharp, ARNP, CRNA
• Delanie Sharpe, APRN
• Catherine Marie Shaughnessy, LPN

• Clinic/Center in Lake City, FL
• Providers in Lake City, FL by specialty
• Clinic/Center in Florida

• 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.