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General NPI Number Information
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NPI Number | 1346244845
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Entity Type | Organization
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Legal Business Name | LAKELAND SURGICAL & DIAGNOSTIC CENTER LLP
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Dates
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Enumeration Date | 06/13/2005
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Last Update Date | 03/18/2016
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Provider Practice Location Address
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Address Line | 1315 N FLORIDA AVE
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City | LAKELAND
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State | FL
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Zip | 33805-4502
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Country | US
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Telephone | 863-683-2268
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Fax | 863-683-3717
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Provider Business Mailing Address
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Address Line | 115 S MISSOURI AVE STE 101
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City | LAKELAND
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State | FL
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Zip | 33815-4601
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Country | US
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Telephone | 863-683-2428
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Fax | 863-686-9873
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Authorized Official
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Title or Position | CEO
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Name | MS. EMILY DUNCAN
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Credential |
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Telephone | 863-683-2428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 1038
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License Number State | FL
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