Provider Demographics
NPI:1720591613
Name:LIVE OAK HMA, LLC
Entity Type:Organization
Organization Name:LIVE OAK HMA, LLC
Other - Org Name:SHANDS LIVE OAK REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR / DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-925-4565
Mailing Address - Street 1:1100 11TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-3608
Mailing Address - Country:US
Mailing Address - Phone:386-362-0800
Mailing Address - Fax:
Practice Address - Street 1:1100 11TH ST SW
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-3608
Practice Address - Country:US
Practice Address - Phone:386-362-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIVE OAK HMA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4314275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit