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Organization
SOUTH LAKE HOSPITAL INC
Active
Organization
SOUTH LAKE HOSPITAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE LONGACRE (VICE PRESIDENT)
(407) 237-6393
Entity
Organization
Contact information
Practice address
1900 DON WICKHAM DR, CLERMONT, FL 34711-1979
(352) 241-7275
(352) 241-7281
Mailing address
1900 DON WICKHAM DR, CLERMONT, FL 34711-1979
(352) 241-7275
(352) 241-7281
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
NULL
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
Primary
—
NULL
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
208800000X
Urology Physician
—
NULL
208800000X
Urology Physician
—
—
Other
Enumeration date
12/13/2007
Last updated
08/25/2014
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