ADVENTHEALTH POLK SOUTH INC (NPI# 1053972760) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053972760 |
| Entity Type | Organization |
| Organization Name | ADVENTHEALTH POLK SOUTH INC |
| Other Organization Name | ADVENTHEALTH LAKE WALES |
| Practice Address |
410 S 11th St Lake Wales FL 33853-4203 |
| Practice Telephone | 8636761433 |
| Practice Fax Number | 8632971867 |
| Mailing Telephone | 8636761433 |
| Mailing Fax Number | 8632971867 |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2019-07-22 |
| Authorized Official Name | COY L INGRAM (VICE PRESIDENT, REVENUE CYCLE) |
| Authorized Official Telephone | 4072002270 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 273R00000X | Psychiatric Unit | Hospital Units | ||
| Y | 282N00000X | General Acute Care Hospital | Hospitals |
| Other Name | Type Code |
|---|---|
| AdventHealth Lake Wales | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033770284 | Adventhealth Polk South Inc | Psychiatric Unit | 410 S 11th St, Lake Wales, FL 33853-4203 | 2019-06-27 |
| Street Address |
410 S 11TH ST |
| City | LAKE WALES |
| State | FL |
| Zip Code | 33853-4203 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457350027 | Lake Wales Clinic Corp | Surgery | 410 S 11th St, Lake Wales, FL 33853-4203 | 2005-07-18 |
| 1811508476 | Marianne Dimetry | Pharmacist | 410 S 11th St, Lake Wales, FL 33853-4203 | 2020-08-16 |
| 1033770284 | Adventhealth Polk South Inc | Psychiatric Unit | 410 S 11th St, Lake Wales, FL 33853-4203 | 2019-06-27 |
| 1164902797 | Lake Wales Physician Services, LLC | Physician Assistant | 410 S 11th St, Lake Wales, FL 33853-4203 | 2018-08-14 |
| 1336689819 | Panchami Thomas | Nurse Practitioner | 410 S 11th St, Lake Wales, FL 33853-4203 | 2017-03-02 |
| 1992259477 | Dawn Michelle Shepard | Nurse Practitioner | 410 S 11th St, Lake Wales, FL 33853-4203 | 2016-08-12 |
| 1841696762 | Lake Wales Hospital Corporation | Psychiatric Unit | 410 S 11th St, Lake Wales, FL 33853-4203 | 2014-11-05 |
| 1003238684 | Matt Moraes | Anesthesiologist Assistant | 410 S 11th St, Lake Wales, FL 33853-4203 | 2014-01-15 |
| 1063859262 | Michael F Cunningham | Emergency Medicine | 410 S 11th St, Lake Wales, FL 33853-4203 | 2013-05-29 |
| 1902141773 | Benjamin Elliot Lippmann | Psychiatry & Neurology | 410 S 11th St, Lake Wales, FL 33853-4203 | 2012-12-05 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881218998 | Marcel Fundora | Dentist | 701 Fl-60, Lake Wales, FL 33853 | 2020-06-04 |
| 1386291599 | Adventist Health System /sunbelt, Inc. | Clinic/Center | 1255 Florida 60, Suite 300, Lake Wales, FL 33853 | 2019-08-22 |
| 1932753472 | Adeline Brooke Warren | Occupational Therapist | 512 S 11th Street, Lake Wales, FL 33853 | 2019-08-01 |
| 1033563580 | Amber Y Shepard | Family Medicine | 1255 Highway 60 E Ste 500, Lake Wales, FL 33853 | 2016-04-21 |
| 1174982458 | Ledesha Marie Dorothy Maduro | Dentist | 24185 Us Hwy 27 North, Lake Wales, FL 33853 | 2016-02-16 |
| 1528402435 | Buck Andreu Scott | Surgery | 407 S 11th St, Lake Wales, FL 33853 | 2013-04-22 |
| 1447598321 | Central Florida Health Care, Inc. | Dentist | 305 West Central Avenue, Lake Wales, FL 33853 | 2013-01-28 |
| 1972864932 | Kevin T Barlow, Pa. Dba: Winter Haven Audiology and Ridge Audiology. | Clinic/Center | 704 Sr 60 East, Lake Wales, FL 33853 | 2012-06-06 |
| 1316266364 | Elba M Lopez | Massage Therapist | 318 S. First Street, Lake Wales, FL 33853 | 2010-05-28 |
| 1063657955 | Lake Wales Medical Imaging Center One, Inc | Technician, Health Information | 1255 Highway 60 East 110, Lake Wales, FL 33853 | 2008-12-08 |
| Find all providers in zip 33853 | ||||
| Taxonomy Code | 282N00000X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| An acute general hospital is an institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medical conditions, both surgical and non-surgical, to a wide population group. The hospital treats patients in an acute phase of illness or injury, characterized by a single episode or a fairly short duration, from which the patient returns to his or her normal or previous level of activity. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033180195 | Lake Wales Hospital Corporation | General Acute Care Hospital | 410 S 11th St, Lake Wales, FL 33853-4203 | 2006-01-27 |
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| 1659803435 | Palmetto General Hosptial | General Acute Care Hospital | 2001 West 68th St, Suite 202, Hialeah, FL 33016 | 2017-03-30 |
| Find all providers with the same taxonomy | ||||
| City | LAKE WALES |
| Zip Code | 33853 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.