Healthcare Provider Details

I. General information

NPI: 1043121171
Provider Name (Legal Business Name): LAKELAND REGIONAL HEALTH SYSTEMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 E GARDEN ST
LAKELAND FL
33805-4615
US

IV. Provider business mailing address

1324 LAKELAND HILLS BLVD ATTN: MANAGED CARE
LAKELAND FL
33805-4543
US

V. Phone/Fax

Practice location:
  • Phone: 863-683-5454
  • Fax: 863-683-4652
Mailing address:
  • Phone: 863-687-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LANCE GREEN
Title or Position: EVP/CFO
Credential:
Phone: 863-687-1100