Organization
LAKELAND REGIONAL HEALTH SYSTEMS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LANCE GREEN (EVP/CFO)
(863) 687-1100
Entity
Organization
Contact information
Practice address
901 S LAKESIDE AVE, LAKELAND, FL 33803-1022
(863) 638-5433
(863) 688-5521
Mailing address
1324 LAKELAND HILLS BLVD, MANAGED CARE DEPT, LAKELAND, FL 33805
(863) 687-1100
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RI0200X
Infectious Disease Physician
—
—
208D00000X
General Practice Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
263421019
—
FL
Enumeration date
10/01/2021
Last updated
01/04/2023
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