Basic Information
| Provider Information | |||||||||
| NPI: | 1275600967 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LAKELAND COMMUNITY HOSPITAL, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | LAKELAND COMMUNITY HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 42024 HIGHWAY 195 | ||||||||
| Address2: | |||||||||
| City: | HALEYVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 355657054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2054865213 | ||||||||
| FaxNumber: | 2054857127 | ||||||||
| Practice Location | |||||||||
| Address1: | 42024 HIGHWAY 195 | ||||||||
| Address2: | |||||||||
| City: | HALEYVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 355657054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2054865213 | ||||||||
| FaxNumber: | 2054857127 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2006 | ||||||||
| LastUpdateDate: | 05/10/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MUKHERJI | ||||||||
| AuthorizedOfficialFirstName: | ASHOKE 'BAPPA' | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | JAVA MEDICAL GROUP CEO | ||||||||
| AuthorizedOfficialTelephone: | 6153088800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 05/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | N | Hospitals | General Acute Care Hospital | 282NR1301X | 10418 | AL | Y | Hospitals | General Acute Care Hospital | Rural |
ID Information
| ID | Type | State | Issuer | Description | HOS0125H | 05 | AL | MEDICAID |