# LAKELAND REGIONAL HEALTH SYSTEM, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pavillion - OBGYN
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487068672
- **Authorized official:** LANCE GREEN (VP / CFO)
- **Authorized official phone:** (863) 687-1100

## Contact information

- **Practice address:** 1324 LAKELAND HILLS BLVD, PAVILLION - OBGYN, LAKELAND, FL 33805-4543
- **Practice address phone:** (863) 284-6860
- **Practice address fax:** (863) 688-7959
- **Mailing address:** 1324 LAKELAND HILLS BLVD, LAKELAND, FL 33805-4543
- **Mailing address phone:** (863) 687-1100

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 208D00000X | General Practice Physician | — | — | Yes |
| 261QM1300X | Multi-Specialty Clinic/Center | — | FL | — |
| 363LX0001X | Obstetrics & Gynecology Nurse Practitioner | — | — | — |
| 367A00000X | Advanced Practice Midwife | — | — | — |

## Other

- **Enumeration date:** 06/16/2014
- **Last updated:** 01/04/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 263421009 | — | FL |