Florida Lakes Surgical PLLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

FLORIDA LAKES SURGICAL PLLC

Practice address

4751 Lakeview Dr
Sebring, FL 33870-2064

Phone

(863) 402-5600

Fax

(863) 402-5602

NPI assigned

Jun 13, 2007

Last updated

May 11, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Thomas C Lackey II, DONPI 1114955598

Title

Owner

Phone

86340265600

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Thomas C. Lackey II, D. O.

  • Surgery Physician
  • Sebring, FL
  • NPI 1114955598
  Medicare reassignment NPD Authorized official
• Mayelin Fernandez Fuentes, APRN

  • Geriatric Medicine (Family Medicine) Physician
  • Sebring, FL
  • NPI 1457021081
  NPD
• Melina Davita Hoffman, NP

  • Nurse Practitioner
  • Sebring, FL
  • NPI 1083066070
  NPD
• Lauren Ann Woomer, PA-C

  • Physician Assistant
  • Venice, FL
  • NPI 1033815113
  NPD (past)

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

{
    "created_epoch": "1181692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431302400000",
    "number": "1174727937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4751 LAKEVIEW DR",
            "city": "SEBRING",
            "state": "FL",
            "postal_code": "338702064",
            "telephone_number": "863-402-5600",
            "fax_number": "863-402-5602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4751 LAKEVIEW DR",
            "city": "SEBRING",
            "state": "FL",
            "postal_code": "338702064",
            "telephone_number": "863-402-5600",
            "fax_number": "863-402-5602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA LAKES SURGICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-13",
        "last_updated": "2015-05-11",
        "status": "A",
        "authorized_official_last_name": "LACKEY",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "86340265600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "279537000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Florida Em-I Medical Services, PA
• Florida ENT Associates, Inc. (South Florida ENT Associates, Inc.)
• Florida Injury Chiropractic LLC
• Florida Joint & Spine Institute PA
• Florida Lakes Anesthesia LLC
• Florida Physicians Medical Group (Highlands Surgical Associates)
• Florida Radiology Management LLC
• Florida Rheumatology Associates Inc
• Florida Senior Living, LLC (Palms Home Care)
• Florida Woman Care LLC

• Surgery Physician in Sebring, FL
• Providers in Sebring, FL by specialty
• Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.