# LAKELAND REGIONAL HEALTH SYSTEMS, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lake Miriam Campus
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063858538
- **Authorized official:** LANCE GREEN (VP/CFO)
- **Authorized official phone:** (863) 687-1100

## Contact information

- **Practice address:** 4710 S FLORIDA AVE, LAKELAND, FL 33813-2165
- **Practice address phone:** (863) 284-6800
- **Practice address fax:** (863) 284-6807
- **Mailing address:** 1324 LAKELAND HILLS BLVD, MANAGED CARE DEPT, LAKELAND, FL 33805
- **Mailing address phone:** (863) 687-1100
- **Mailing address fax:** (863) 630-6528

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | FL | Yes |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 05/10/2013
- **Last updated:** 01/24/2023