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General NPI Number Information
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NPI Number | 1336221019
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Entity Type | Organization
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Legal Business Name | SOUTH LAKE HOSPITAL, INC.
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 1900 DON WICKHAM DR
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City | CLERMONT
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State | FL
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Zip | 34711-1947
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Country | US
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Telephone | 352-394-4071
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Fax |
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Provider Business Mailing Address
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Address Line | 1414 KUHL AVE
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City | ORLANDO
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State | FL
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Zip | 32806-2008
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Country | US
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Telephone | 321-841-5111
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Fax | 407-650-3785
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Authorized Official
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Title or Position | CHIEF REVENUE OFFICER
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Name | MICHELE TYNES NAPIER
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Credential |
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Telephone | 407-650-3763
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 4180
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License Number State | FL
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