NPIMap

Organization Active NPI

Lakeland Regional Health Systems, Inc.

  • Multi-Specialty Clinic/Center
  • Winter Haven, FL
National Provider Identifier
1053757526
Registry record updated Jan 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
LAKELAND REGIONAL HEALTH SYSTEMS, INC.
Practice address
430 E Central Ave
Winter Haven, FL 33880-3050
Phone
(863) 284-6850
Fax
(863) 284-6853
NPI assigned
May 10, 2013
Last updated
Jan 4, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lance Green
Title
VP, Cfo
Phone
(863) 687-1100

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X FL Primary
Pediatric Nurse Practitioner 363LP0200X NU
Family Medicine Physician 207Q00000X NU
Pediatrics Physician 208000000X NU
General Practice Physician 208D00000X NU

Addresses

Primary practice location

430 E Central Ave
Winter Haven, FL 33880-3050

Mailing address

1324 Lakeland Hills Blvd
Managed Care Dept
Lakeland, FL 33805
Phone (863) 687-1100

Other identifiers 1

IdentifierTypeStateIssuer
263421004MedicaidFL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0293299Lakeland Regional Health430 E Central Ave, Winter Haven, FL 33880Certificate of waiverMar 30, 2028

National Provider Directory

National Provider Directory
Tax ID family
Lakeland Regional HLTH Syst36 organizations share this tax ID, including this one

Other organizations with this tax ID 35

Organizations that report the same tax identification number in the National Provider Directory.

View all 35

Locations

430 E Central Ave
Winter Haven, FL 33880
Phone (863) 284-5061

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1368144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672790400000",
    "number": "1053757526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1324 LAKELAND HILLS BLVD",
            "address_2": "MANAGED CARE DEPT",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "33805",
            "telephone_number": "863-687-1100",
            "fax_number": "863-630-6528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 E CENTRAL AVE",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338803050",
            "telephone_number": "863-284-6850",
            "fax_number": "863-284-6853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKELAND REGIONAL HEALTH SYSTEMS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-10",
        "last_updated": "2023-01-04",
        "certification_date": "2023-01-04",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "LANCE",
        "authorized_official_title_or_position": "VP, CFO",
        "authorized_official_telephone_number": "863-687-1100"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "FL",
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "263421004",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winter Haven, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.