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General NPI Number Information
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NPI Number | 1457350027
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Entity Type | Organization
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Legal Business Name | LAKE WALES CLINIC CORP
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Dates
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Enumeration Date | 07/18/2005
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Last Update Date | 07/22/2019
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Provider Practice Location Address
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Address Line | 410 S 11TH ST
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City | LAKE WALES
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State | FL
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Zip | 33853-4203
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Country | US
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Telephone | 863-676-1433
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 689022
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City | FRANKLIN
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State | TN
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Zip | 37068-9022
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Country | US
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Telephone | 615-778-8196
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Fax | 615-628-6877
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Authorized Official
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Title or Position | VP PHYSICIAN BUSINESS SERVICES
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Name | JAMES P WRIGHT
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Credential |
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Telephone | 615-778-1502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #5
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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 |
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Taxonomy #6
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 2084S0012X
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Taxonomy Name | Sleep Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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