Organization
LAKELAND FL ENDOSCOPY ASC LLC
Active
Other names
Surgery Center of Lakeland Hills Boulevard
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHILLIP A CLENDENIN (PRESIDENT)
(615) 665-1283
Entity
Organization
Contact information
Practice address
3340 LAKELAND HILLS BLVD, LAKELAND, FL 33805-1974
(863) 682-3239
(863) 682-3462
Mailing address
3340 LAKELAND HILLS BLVD, LAKELAND, FL 33805-1974
(863) 682-3239
(863) 682-3462
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
1230
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
075976700
—
FL
01
—
P00221727
RAILROAD MEDICARE
FL
Enumeration date
02/15/2006
Last updated
09/07/2023
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