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Organization
LAKE WALES HOSPITAL CORPORATION
Active
Organization
LAKE WALES HOSPITAL CORPORATION
Active
Other names
Lake Wales Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
PAULA M LALOR (DIRECTOR/DELEGATED OFFICIAL)
(615) 925-4565
Entity
Organization
Contact information
Practice address
410 S 11TH ST, LAKE WALES, FL 33853-4203
(863) 676-1433
Mailing address
PO BOX 403164, ATLANTA, GA 30384-3164
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
4007
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010166400
—
FL
01
—
101662
AV-MED
—
01
—
501
BCBS
—
Enumeration date
01/27/2006
Last updated
03/09/2018
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