MEDICARE: PALM MEDICAL CENTER LAKELAND LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760177067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALM MEDICAL CENTER LAKELAND LLC

Provider Business Mailing Address
First Line	:	263 US HIGHWAY 27 N
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33870-2146
Country	:	US
Telephone Number	:	863-593-4333
Fax Number	:

Provider Business Practice Location Address
First Line	:	263 US HIGHWAY 27 N
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33870-2146
Country	:	US
Telephone Number	:	863-593-4333
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT CENTER OPERATIONS
Name	:	SANTIAGO MOISES MARTIN
Credential	:
Telephone Number	:	305-913-9441

Provider Enumeration Date	:	04/11/2023
Last Update Date	:	04/11/2023

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