LAKELAND REGIONAL HEALTH SYSTEMS, INC. (NPI# 1063858538) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063858538 |
| Entity Type | Organization |
| Organization Name | LAKELAND REGIONAL HEALTH SYSTEMS, INC. |
| Other Organization Name | LAKE MIRIAM CAMPUS |
| Practice Address |
4710 S Florida Ave Lakeland FL 33813-2165 |
| Mailing Address |
1324 Lakeland Hills Blvd Managed Care Dept Lakeland FL 33805 |
| Practice Telephone | 8632846800 |
| Practice Fax Number | 8632846807 |
| Mailing Telephone | 8636871100 |
| Mailing Fax Number | 8636306528 |
| Enumeration Date | 2013-05-10 |
| Last Update Date | 2020-07-21 |
| Authorized Official Name | LANCE GREEN (VP/CFO) |
| Authorized Official Telephone | 8636871100 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
FL | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Clark & Daughtrey-Lakeside WI | Doing Business As Name - Organization |
| Lake Miriam Campus | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114393469 | Lakeland Regional Health Systems, Inc. | General Practice | 811 S Lakeside Ave, Lakeland, FL 33815-4771 | 2015-08-20 |
| 1184820037 | Lakeland Regional Health Systems, Inc. | Internal Medicine | 320 Parkviewpl, Lakeland, FL 33805 | 2007-06-26 |
| 1083095129 | Lakeland Regional Health Systems, Inc. | Clinic/Center | 208 Main St, Auburndale, FL 33823-3404 | 2015-06-15 |
| 1508258906 | Lakeland Regional Health Systems, Inc. | Clinic/Center | 3015 Lakeland Highlands Rd, Lakeland, FL 33803-4339 | 2015-02-23 |
| 1609280635 | Lakeland Regional Health Systems, Inc. | Clinic/Center | 3525 Lakeland Hills Blvd, Lakeland, FL 33805-1965 | 2014-06-18 |
| 1619381803 | Lakeland Regional Health Systems, Inc. | Clinic/Center | 4700 Research Way, Lakeland, FL 33805-8531 | 2014-06-16 |
| 1053757526 | Lakeland Regional Health Systems, Inc. | Clinic/Center | 430 E Central Ave, Winter Haven, FL 33880-3050 | 2013-05-10 |
| 1831534312 | Lakeland Regional Health Systems, Inc. | Clinic/Center | 1324 Lakeland Hills Blvd, Lakeland, FL 33805-4543 | 2013-05-09 |
| 1902241482 | Lakeland Regional Health Systems, Inc. | Clinic/Center | 2815 Lakeland Hills Blvd, Lakeland, FL 33805-2224 | 2013-05-09 |
| 1669817144 | Lakeland Regional Health Systems, Inc. | Clinic/Center | 3030 Harden Blvd, Lakeland, FL 33803-7952 | 2013-05-09 |
| Street Address |
4710 S FLORIDA AVE |
| City | LAKELAND |
| State | FL |
| Zip Code | 33813-2165 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801890462 | Ruben D Adriano | Internal Medicine | 4710 S Florida Ave, Lakeland, FL 33813-2165 | 2005-06-10 |
| 1386146215 | Shivani Patel | Nurse Practitioner | 4710 S Florida Ave, Lakeland, FL 33813 | 2018-03-07 |
| 1659870350 | Steven Ray Betteridge II | Nurse Practitioner | 4710 S Florida Ave, Lakeland, FL 33813 | 2018-02-08 |
| 1407355217 | Shirley Gwen Rogerson | Registered Nurse | 4710 S Florida Ave, Lakeland, FL 33813-2165 | 2018-02-07 |
| 1851803407 | Radiology & Imaging Specialists of Lakeland, Pa | Radiology | 4710 S Florida Ave, Lakeland, FL 33813-2165 | 2017-11-03 |
| 1407203821 | Kessarin Gustafson | Nurse Practitioner | 4710 S Florida Ave, Lakeland, FL 33813-2165 | 2016-05-16 |
| 1134580053 | Paul Stephen Kent Jr. | Nurse Practitioner | 4710 S Florida Ave, Lakeland, FL 33813-2165 | 2016-03-20 |
| 1417312471 | Jackie Barnes | Nurse Practitioner | 4710 S Florida Ave, Lakeland, FL 33813-2165 | 2015-12-17 |
| 1740651272 | Nwamaka Ilonzo | Nurse Practitioner | 4710 S Florida Ave, Lakeland, FL 33813-2165 | 2015-10-09 |
| 1417353665 | Kelly Bolin | Nurse Practitioner | 4710 S Florida Ave, Lakeland, FL 33813 | 2014-11-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427600030 | Genesis Vieyra Lopez | Nurse Practitioner | 631 Mid Florida Drive, Lakeland, FL 33813 | 2019-07-13 |
| 1306323340 | Sandrene Smart | Clinic/Center | 625 Commerce Dr. (suite 103), Lakeland, FL 33813 | 2018-07-23 |
| 1033560586 | Charles D. Llano, D.d.s. | Dentist | 320 West Highland Drive, Lakeland, FL 33813 | 2016-06-27 |
| 1417317389 | Eye Specialists of Mid-florida, Pa | Ophthalmology | 2004 Cr 540 A, Lakeland, FL 33813 | 2016-03-04 |
| 1609234905 | Care and Life LLC | In Home Supportive Care | 6526 Fox Tree Lane, Lakeland, FL 33813 | 2016-02-02 |
| 1558731158 | Lori Ann Smith | Nurse Practitioner | 6030 S. Florida Ave, Suite 110, Lakeland, FL 33813 | 2015-09-25 |
| 1891182143 | Advanced Integrated Care Organization, LLC | Health Maintenance Organization | 5423 S. Florida Ave, Lakeland, FL 33813 | 2015-04-23 |
| 1902292352 | Central Health Associates | Internal Medicine | 4925 Old Rd 37, Lakeland, FL 33813 | 2015-04-13 |
| 1134542848 | Gledia Lovering | Dietitian, Registered | 6420 Highlands In The Woods St, Lakeland, FL 33813 | 2014-01-31 |
| 1134556368 | Billy Rogers | Nurse Anesthetist, Certified Registered | 4513 Orangewood Loop W., Lakeland, FL 33813 | 2013-10-02 |
| Find all providers in zip 33813 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013409598 | Ethos Health Lakeland, LLC | Clinic/Center | 625 Commerce Dr Ste 104, Lakeland, FL 33813-2733 | 2018-05-31 |
| 1053943787 | Bond Clinic Pa | Clinic/Center | 2039 E Edgewood Dr, Lakeland, FL 33803-3601 | 2020-02-11 |
| 1396217089 | Draughn Butler LLC | Clinic/Center | 2033 E Edgewood Dr Ste 4, Lakeland, FL 33803-3660 | 2018-12-19 |
| 1508258906 | Lakeland Regional Health Systems, Inc. | Clinic/Center | 3015 Lakeland Highlands Rd, Lakeland, FL 33803-4339 | 2015-02-23 |
| 1609280635 | Lakeland Regional Health Systems, Inc. | Clinic/Center | 3525 Lakeland Hills Blvd, Lakeland, FL 33805-1965 | 2014-06-18 |
| 1619381803 | Lakeland Regional Health Systems, Inc. | Clinic/Center | 4700 Research Way, Lakeland, FL 33805-8531 | 2014-06-16 |
| 1487068672 | Lakeland Regional Health System, Inc. | Clinic/Center | 1324 Lakeland Hills Blvd, Pavillion - Obgyn, Lakeland, FL 33805-4543 | 2014-06-16 |
| 1831534312 | Lakeland Regional Health Systems, Inc. | Clinic/Center | 1324 Lakeland Hills Blvd, Lakeland, FL 33805-4543 | 2013-05-09 |
| 1902241482 | Lakeland Regional Health Systems, Inc. | Clinic/Center | 2815 Lakeland Hills Blvd, Lakeland, FL 33805-2224 | 2013-05-09 |
| 1669817144 | Lakeland Regional Health Systems, Inc. | Clinic/Center | 3030 Harden Blvd, Lakeland, FL 33803-7952 | 2013-05-09 |
| Find all providers in LAKELAND | ||||
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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.