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Organization
LAKELAND REGIONAL HEALTH SYSTEMS, INC.
Active
Organization
LAKELAND REGIONAL HEALTH SYSTEMS, INC.
Active
Other names
Lake Miriam Campus
Organization subpart
No
Provider details
NPI number
Authorized official
LANCE GREEN (VP/CFO)
(863) 687-1100
Entity
Organization
Contact information
Practice address
4710 S FLORIDA AVE, LAKELAND, FL 33813-2165
(863) 284-6800
(863) 284-6807
Mailing address
1324 LAKELAND HILLS BLVD, MANAGED CARE DEPT, LAKELAND, FL 33805
(863) 687-1100
(863) 630-6528
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
NULL
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
208D00000X
General Practice Physician
—
NULL
208D00000X
General Practice Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
FL
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
05/10/2013
Last updated
01/24/2023
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