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Organization
LAKELAND REGIONAL HEALTH SYSTEM, INC
Active
Organization
LAKELAND REGIONAL HEALTH SYSTEM, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LANCE GREEN (CFO)
(863) 687-1100
Entity
Organization
Contact information
Practice address
3644 INNOVATION DR, LAKELAND, FL 33812-4105
(863) 284-1583
(863) 413-4822
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
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
263421022
—
FL
Enumeration date
08/20/2015
Last updated
04/10/2023
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