Basic Information
| Provider Information | |||||||||
| NPI: | 1215609011 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAKELAND REGIONAL HEALTH SYSTEM, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 455 EMERALD AVE | ||||||||
| Address2: | |||||||||
| City: | LAKE WALES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338534716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636760014 | ||||||||
| FaxNumber: | 8632846825 | ||||||||
| Practice Location | |||||||||
| Address1: | 455 EMERALD AVE | ||||||||
| Address2: | |||||||||
| City: | LAKE WALES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338534716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636760014 | ||||||||
| FaxNumber: | 8632846825 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2021 | ||||||||
| LastUpdateDate: | 09/30/2021 | ||||||||
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| AuthorizedOfficialLastName: | GREEN | ||||||||
| AuthorizedOfficialFirstName: | LANCE | ||||||||
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| AuthorizedOfficialTitleorPosition: | EVP/CFO | ||||||||
| AuthorizedOfficialTelephone: | 8636871100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | EVP/CFO | ||||||||
| NPICertificationDate: | 09/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.