NPIMap

Organization Active NPI

Lakeland Regional Health System, Inc

  • General Practice Physician
  • Lakeland, FL
National Provider Identifier
1114393469
Registry record updated Apr 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
LAKELAND REGIONAL HEALTH SYSTEM, INC
Practice address
3644 Innovation Dr
Lakeland, FL 33812-4105
Phone
(863) 284-1583
Fax
(863) 413-4822
NPI assigned
Aug 20, 2015
Last updated
Apr 10, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2023

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

Authorized official

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU
Physician Assistant 363A00000X NU
Surgical Physician Assistant 363AS0400X NU
General Practice Physician 208D00000X NU Primary
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician 207VF0040X NU

Addresses

Primary practice location

3644 Innovation Dr
Lakeland, FL 33812-4105

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
263421022MedicaidFL

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
10D2257299Lakeland Regional Health3644 Innovation Dr, Lakeland, FL 33812Certificate of waiverApr 3, 2028

National Provider Directory

National Provider Directory
Tax ID family
Lakeland Regional Health Systems Inc36 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

NPI Registry JSON

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

{
    "created_epoch": "1440028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681084800000",
    "number": "1114393469",
    "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": "3644 INNOVATION DR",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338124105",
            "telephone_number": "863-284-1583",
            "fax_number": "863-413-4822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKELAND REGIONAL HEALTH SYSTEM, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-20",
        "last_updated": "2023-04-10",
        "certification_date": "2023-04-10",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "LANCE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "863-687-1100"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207VF0040X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "263421022",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeland, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 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.