# SOUTH LAKE HOSPITAL INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265615124
- **Authorized official:** LESLIE LONGACRE (VICE PRESIDENT)
- **Authorized official phone:** (407) 237-6393

## Contact information

- **Practice address:** 1900 DON WICKHAM DR, CLERMONT, FL 34711-1979
- **Practice address phone:** (352) 241-7275
- **Practice address fax:** (352) 241-7281
- **Mailing address:** 1900 DON WICKHAM DR, CLERMONT, FL 34711-1979
- **Mailing address phone:** (352) 241-7275
- **Mailing address fax:** (352) 241-7281

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | NULL | — |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | — | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |
| 208800000X | Urology Physician | — | NULL | — |
| 208800000X | Urology Physician | — | — | — |

## Other

- **Enumeration date:** 12/13/2007
- **Last updated:** 08/25/2014