Organization
HEARTLAND PEDIATRICS OF LAKE WALES, LLC
Active
Other names
HEARTLAND PEDIATRICS OF LAKE WALES, P.A.
Organization subpart
No
Provider details
NPI number
Authorized official
LAURENCE THOMAS HREN (CEO)
(863) 676-1770
Entity
Organization
Contact information
Practice address
1354 STATE ROAD 60 E, LAKE WALES, FL 33853-4322
(863) 679-8888
(863) 676-2851
Mailing address
1354 STATE ROAD 60 E, LAKE WALES, FL 33853-4322
(863) 679-8888
(863) 676-2851
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
261QR1300X
Rural Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21247
BLUE CROSS BLUE SHIELD
FL
05
—
251469900
—
FL
05
—
251469901
—
FL
Enumeration date
12/18/2006
Last updated
01/08/2025
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