Healthcare Provider Details

I. General information

NPI: 1265453203
Provider Name (Legal Business Name): HEARTLAND PEDIATRICS OF LAKE PLACID, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 E ROYAL PALM ST SUITE # 3
LAKE PLACID FL
33852-5020
US

IV. Provider business mailing address

344 E ROYAL PALM ST SUITE # 3
LAKE PLACID FL
33852-5020
US

V. Phone/Fax

Practice location:
  • Phone: 863-699-1414
  • Fax: 863-699-9790
Mailing address:
  • Phone: 863-699-1414
  • Fax: 863-699-9790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAURENCE THOMAS HREN
Title or Position: CEO
Credential:
Phone: 863-676-1770