Organization
LAKELAND REGIONAL HEALTH SYSTEM, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LANCE GREEN EVP/CFO (EVP/CFO)
(863) 687-1100
Entity
Organization
Contact information
Practice address
455 EMERALD AVE, LAKE WALES, FL 33853-4716
(863) 676-0014
(863) 284-6825
Mailing address
ATTN MANAGED CARE DEPARTMENT, 1324 LAKELAND HILLS BLVD, LAKELAND, FL 33805
(863) 687-1100
(863) 284-6825
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
2086X0206X
Surgical Oncology Physician
—
—
208D00000X
General Practice Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
263421021
—
FL
Enumeration date
09/30/2021
Last updated
04/05/2024
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