MEDICARE: LAKELAND REGIONAL HEALTH SYSTEMS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	208D00000X	General Practice Physician
3	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1083463129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKELAND REGIONAL HEALTH SYSTEMS, INC.

Provider Business Mailing Address
First Line	:	1324 LAKELAND HILLS BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33805-4543
Country	:	US
Telephone Number	:	863-687-1100
Fax Number	:

Provider Business Practice Location Address
First Line	:	930 MARCUM RD STE 10
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33809-4308
Country	:	US
Telephone Number	:	863-284-6800
Fax Number	:	863-284-1669

Authorized Official
Title or Position	:	EVP/CFO
Name	:	LANCE GREEN
Credential	:
Telephone Number	:	863-687-1100

Provider Enumeration Date	:	05/13/2024
Last Update Date	:	10/08/2024

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