Provider Demographics
NPI:1235553082
Name:LEESBURG REGIONAL MEDICAL CENTER INC.
Entity Type:Organization
Organization Name:LEESBURG REGIONAL MEDICAL CENTER INC.
Other - Org Name:LEESBURG REGIONAL MEDICAL CENTER URGENT CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP / CFO
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-323-5762
Mailing Address - Street 1:550 E. DIXIE AVE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748
Mailing Address - Country:US
Mailing Address - Phone:352-323-2273
Mailing Address - Fax:352-323-2261
Practice Address - Street 1:550 E. DIXIE AVE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748
Practice Address - Country:US
Practice Address - Phone:352-323-2273
Practice Address - Fax:352-323-2261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-14
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center