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General NPI Number Information
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NPI Number | 1265453203
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Entity Type | Organization
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Legal Business Name | HEARTLAND PEDIATRICS OF LAKE PLACID, INC.
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 344 E ROYAL PALM ST SUITE # 3
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City | LAKE PLACID
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State | FL
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Zip | 33852-5020
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Country | US
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Telephone | 863-699-1414
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Fax | 863-699-9790
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Provider Business Mailing Address
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Address Line | 344 E ROYAL PALM ST SUITE # 3
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City | LAKE PLACID
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State | FL
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Zip | 33852-5020
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Country | US
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Telephone | 863-699-1414
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Fax | 863-699-9790
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Authorized Official
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Title or Position | CEO
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Name | LAURENCE THOMAS HREN
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Credential |
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Telephone | 863-676-1770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | FL
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