Provider Demographics
NPI:1780621607
Name:PRIMARY MEDICAL CENTER OF LAKELAND, LLC
Entity type:Organization
Organization Name:PRIMARY MEDICAL CENTER OF LAKELAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUERRIER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:863-687-4575
Mailing Address - Street 1:1417 LAKELAND HILLS BLVD
Mailing Address - Street 2:SUITE #106
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3200
Mailing Address - Country:US
Mailing Address - Phone:863-687-4575
Mailing Address - Fax:863-616-1342
Practice Address - Street 1:1417 LAKELAND HILLS BLVD
Practice Address - Street 2:SUITE #106
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3200
Practice Address - Country:US
Practice Address - Phone:863-687-4575
Practice Address - Fax:863-616-1342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME27448173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty