Provider Demographics
NPI:1437451887
Name:LAKE MARY MEDICAL CENTER
Entity Type:Organization
Organization Name:LAKE MARY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-333-7995
Mailing Address - Street 1:3629 LAKE EMMA RD
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-6199
Mailing Address - Country:US
Mailing Address - Phone:407-333-7995
Mailing Address - Fax:407-333-7996
Practice Address - Street 1:3629 LAKE EMMA RD
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-6199
Practice Address - Country:US
Practice Address - Phone:407-333-7995
Practice Address - Fax:407-333-7996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty