Provider Demographics
NPI:1245226190
Name:LEESBURG REGIONAL MEDICAL CENTER INC
Entity Type:Organization
Organization Name:LEESBURG REGIONAL MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:352-733-1600
Mailing Address - Street 1:600 E. DIXIE AVENUE
Mailing Address - Street 2:ATTN: REIMBURSEMENT DEPT.
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-5994
Mailing Address - Country:US
Mailing Address - Phone:352-323-5762
Mailing Address - Fax:352-323-5039
Practice Address - Street 1:600 E DIXIE AVE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5925
Practice Address - Country:US
Practice Address - Phone:352-323-5762
Practice Address - Fax:352-323-5239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL282N00000X
282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL328OtherBLUE CROSS ID
FL010107900Medicaid
FL010107900Medicaid
FL010107900Medicaid