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Organization
LAKELAND REGIONAL HEALTH SYSTEM, INC.
Active
Organization
LAKELAND REGIONAL HEALTH SYSTEM, INC.
Active
Other names
Pavillion - OBGYN
Organization subpart
No
Provider details
NPI number
Authorized official
LANCE GREEN (VP / CFO)
(863) 687-1100
Entity
Organization
Contact information
Practice address
1324 LAKELAND HILLS BLVD, PAVILLION - OBGYN, LAKELAND, FL 33805-4543
(863) 284-6860
(863) 688-7959
Mailing address
1324 LAKELAND HILLS BLVD, LAKELAND, FL 33805-4543
(863) 687-1100
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
FL
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
—
—
367A00000X
Advanced Practice Midwife
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
263421009
—
FL
Enumeration date
06/16/2014
Last updated
01/04/2023
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