LAKE WALES PHYSICIAN SERVICES, LLC (NPI# 1164902797) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164902797 |
| Entity Type | Organization |
| Organization Name | LAKE WALES PHYSICIAN SERVICES, LLC |
| Practice Address |
410 S 11th St Lake Wales FL 33853-4203 |
| Mailing Address |
200 Corporate Blvd Lafayette LA 70508-3870 |
| Practice Telephone | 8636761433 |
| Mailing Telephone | 8008939698 |
| Enumeration Date | 2018-08-14 |
| Last Update Date | 2018-08-14 |
| Authorized Official Name | LISHA C FALK (VP OF CONTRACTING) |
| Authorized Official Telephone | 8008939698 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 208M00000X | Hospitalist | Allopathic & Osteopathic Physicians |
| 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 |
| 1053972760 | Adventhealth Polk South Inc | Psychiatric Unit | 410 S 11th St, Lake Wales, FL 33853-4203 | 2019-06-24 |
| 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 |
| Find all providers in the same location | ||||
| 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 | 208M00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Hospitalist |
| Hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to Hospital Medicine. The term 'hospitalist' refers to physicians whose practice emphasizes providing care for hospitalized patients. |
| Notes: Source: American Society of Hospital Medicine, 2007. http://www.hospitalmedicine.org/ [7/1/2009: definition aded] Additional Resources: Hospitalist is a recognized fellowship specialty program offered by many medical institutions. There is no board certification for the specialty at this point. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457646903 | Comprehensive Hospitalists of Florida, LLC | Hospitalist | 410 South 11th Street, Lake Wales, FL 33853-4209 | 2011-06-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053927632 | Leonor Balart | Hospitalist | 4302 W Carmen St Unit 5, Tampa, FL 33609-2270 | 2020-09-19 |
| 1114484813 | Best Medical LLC | Hospitalist | 11604 Orange Palm Way, Tampa, FL 33626-4746 | 2019-02-28 |
| 1053878157 | Hospitalists One, LLC | Hospitalist | 900 S Pine Island Rd Ste 205, Plantation, FL 33324-3920 | 2019-02-25 |
| 1548735798 | North Florida Rehab Solutions | Hospitalist | 1675 Riggins Road, Dr Steele Lancaster, Tallahassee, FL 32308 | 2018-10-03 |
| 1538652979 | Geobel Buchillon | Hospitalist | 4308 Alton Rd Ste 860, Miami Beach, FL 33140-4558 | 2018-06-11 |
| 1619469483 | Hospitalis10 Inc | Hospitalist | 5000 W Oklnd Prk Blvd, Lauderdale Lakes, FL 33313-1503 | 2018-06-06 |
| 1013404706 | Florida Medical Professionals LLC | Hospitalist | St. Mary's Medical Center 901 45th Street, West Palm Beach, FL 33407 | 2018-04-18 |
| 1467965947 | Acure Medical Group Corp | Hospitalist | 1261 Sw 153rd Path, Miami, FL 33194-2678 | 2017-11-07 |
| 1760992317 | Casey Miller | Hospitalist | 400 Health Park Blvd Ste 221, St Augustine, FL 32086-5784 | 2017-10-10 |
| 1720598741 | Gabrielle Mount Borrero | Hospitalist | 1611 Nw 12th Ave Rm 316e, Miami, FL 33136-1005 | 2017-10-04 |
| 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.