Provider Demographics
NPI: | 1497748743 |
---|---|
Name: | LAKELAND REGIONAL HEALTH SYSTEMS, INC. |
Entity Type: | Organization |
Organization Name: | LAKELAND REGIONAL HEALTH SYSTEMS, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | SENIOR VP/CFO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | LANCE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | GREEN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 863-687-1100 |
Mailing Address - Street 1: | 1324 LAKELAND HILLS BLVD |
Mailing Address - Street 2: | FINANCE DEPARTMENT |
Mailing Address - City: | LAKELAND |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33805 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 863-687-7251 |
Mailing Address - Fax: | 863-687-1473 |
Practice Address - Street 1: | 1324 LAKELAND HILLS BLVD |
Practice Address - Street 2: | FINANCE DEPARTMENT |
Practice Address - City: | LAKELAND |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33805 |
Practice Address - Country: | US |
Practice Address - Phone: | 863-687-7251 |
Practice Address - Fax: | 863-687-1473 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2005-08-23 |
Last Update Date: | 2023-05-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
163WD0400X, 207L00000X, 207RN0300X, 207RP1001X, 207X00000X, 207XX0801X, 2084P0800X, 2084P0804X, 2086S0102X, 2086S0122X, 2086S0127X, 208D00000X, 208G00000X, 261QM1300X | ||
FL | 800018020 | 261QM1300X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | |
No | 163WD0400X | Nursing Service Providers | Registered Nurse | Diabetes Educator | Group - Multi-Specialty |
No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
No | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | Group - Multi-Specialty |
No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 207XX0801X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma | Group - Multi-Specialty |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
No | 2086S0102X | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | Group - Multi-Specialty |
No | 2086S0122X | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery | Group - Multi-Specialty |
No | 2086S0127X | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | Group - Multi-Specialty |
No | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty | |
No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 263421000 | Medicaid | |
FL | 263421000 | Medicaid | |
FL | 2471M2300X | Other | ADDITIONAL PROVIDER TAXONOMY |
FL | 34278 | Other | BLUE SHIELD OF FL |
FL | 4734590001 | Medicare NSC | |
FL | 1023216843 | Other | PROVIDER NPI |
FL | K-3569 | Medicare UPIN |