Provider Demographics
NPI:1780070441
Name:LRI MEDICAL
Entity type:Organization
Organization Name:LRI MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:HONG
Authorized Official - Middle Name:
Authorized Official - Last Name:LOSSING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-746-0041
Mailing Address - Street 1:PO BOX 919357
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-9357
Mailing Address - Country:US
Mailing Address - Phone:352-746-1558
Mailing Address - Fax:352-746-3838
Practice Address - Street 1:700 SE 5TH TER
Practice Address - Street 2:STE 5
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-4878
Practice Address - Country:US
Practice Address - Phone:352-364-8558
Practice Address - Fax:352-364-8558
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST FLORIDA MEDICAL ASSOCIATES PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty