Healthcare Provider Details

I. General information

NPI: 1871663153
Provider Name (Legal Business Name): LEESBURG REGIONAL MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E DIXIE AVE
LEESBURG FL
34748-5925
US

IV. Provider business mailing address

600 E DIXIE AVE
LEESBURG FL
34748-5925
US

V. Phone/Fax

Practice location:
  • Phone: 352-323-5762
  • Fax: 352-323-5239
Mailing address:
  • Phone: 352-323-5762
  • Fax: 352-323-5239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: DIANE HARDEN
Title or Position: CFO
Credential:
Phone: 352-323-5002