Provider Demographics
NPI:1902847734
Name:LAKEVIEW OCCUPATIONAL AND INDUSTRIAL CLINIC, P.A.
Entity Type:Organization
Organization Name:LAKEVIEW OCCUPATIONAL AND INDUSTRIAL CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-471-1511
Mailing Address - Street 1:3750 EMERGENCY LN
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-5536
Mailing Address - Country:US
Mailing Address - Phone:863-471-1511
Mailing Address - Fax:863-471-1512
Practice Address - Street 1:3750 EMERGENCY LN
Practice Address - Street 2:SUITE 1
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-5536
Practice Address - Country:US
Practice Address - Phone:863-471-1511
Practice Address - Fax:863-471-1512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4191Medicare ID - Type Unspecified