| Organization Name: | SHANDS TEACHING HOSPITAL & CLINICS INC |
| NPI Number: | 1578659306 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JODI MANSFIELD (SR. VICE PRESIDENT & COO) |
| Mailing Address: | 922 E Call St Starke |
| State: | FL US |
| Postal Code: | 320913616 |
| Phone Number: | 9043682300 |
| Fax Number: | 3523733006 |
| NPI Enumeration Date: | 10/05/2006 |
| NPI Last Update Date: | 06/16/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0200X |
| License Number: | 4267 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Radiology |
| Taxonomy Definition: | |