Provider Demographics
NPI:1184755183
Name:ST LUKES REGIONAL HEALTH CARE PLC
Entity type:Organization
Organization Name:ST LUKES REGIONAL HEALTH CARE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:H
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-644-9800
Mailing Address - Street 1:PO BOX 7396
Mailing Address - Street 2:ST LUKES REGIONAL HEALTH CARE PLC
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33807-7396
Mailing Address - Country:US
Mailing Address - Phone:863-644-9800
Mailing Address - Fax:863-644-9822
Practice Address - Street 1:6030 S FLORIDA AV, STE 110
Practice Address - Street 2:ST LUKES REGIONAL HEALTH CARE PLC
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813
Practice Address - Country:US
Practice Address - Phone:863-644-9800
Practice Address - Fax:863-644-9822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82770207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty