Provider Demographics
NPI:1225174311
Name:LAKELAND HOSPITAL ACQUISITION, LLC
Entity Type:Organization
Organization Name:LAKELAND HOSPITAL ACQUISITION, LLC
Other - Org Name:LAKELAND BEHAVIORAL HEALTH SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP AND SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:FARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-861-6000
Mailing Address - Street 1:6100 TOWER CIR STE 1000
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-1509
Mailing Address - Country:US
Mailing Address - Phone:615-861-6000
Mailing Address - Fax:
Practice Address - Street 1:440 S MARKET AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65806-2026
Practice Address - Country:US
Practice Address - Phone:417-865-0566
Practice Address - Fax:417-865-0566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2023-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7E052083P0901X
MO1016932084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO541287900Medicaid