Organization
LAKELAND REGIONAL HEALTH SYSTEMS, INC.
Active
Other names
Lake Miriam Campus
Organization subpart
No
Provider details
NPI number
Authorized official
LANCE GREEN (VP/CFO)
(863) 687-1100
Entity
Organization
Contact information
Practice address
4710 S FLORIDA AVE, LAKELAND, FL 33813-2165
(863) 284-6800
(863) 284-6807
Mailing address
1324 LAKELAND HILLS BLVD, MANAGED CARE DEPT, LAKELAND, FL 33805
(863) 687-1100
(863) 630-6528
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
208D00000X
General Practice Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
FL
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
263421005
—
FL
Enumeration date
05/10/2013
Last updated
01/24/2023
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