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Organization
LAKE WALES CLINIC CORP
Active
Organization
LAKE WALES CLINIC CORP
Active
Parent organization
LAKE WALES CLINIC CORP
Organization subpart
Yes
Provider details
NPI number
Legal business name
LAKE WALES CLINIC CORP
Authorized official
JAMES P WRIGHT (VP PHYSICIAN BUSINESS SERVICES)
(615) 778-1502
Entity
Organization
Contact information
Practice address
410 S 11TH ST, LAKE WALES, FL 33853-4203
(863) 676-1433
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 778-8196
(615) 628-6877
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
208000000X
Pediatrics Physician
—
—
2084N0600X
Clinical Neurophysiology Physician
—
—
2084S0012X
Sleep Medicine (Psychiatry & Neurology) Physician
—
—
208600000X
Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
26904200
—
FL
01
—
74943
BCBS
FL
Enumeration date
07/18/2005
Last updated
07/22/2019
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