NPIMap

Organization Active NPI

Medical Home Alliance LLC

Doing business as IMA South Lakeland Dispensary

  • Non-Pharmacy Dispensing Site
  • Lakeland, FL
National Provider Identifier
1386173573
Registry record updated Jun 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
Legal business name
MEDICAL HOME ALLIANCE LLC
Doing business as
IMA South Lakeland Dispensary
Practice address
4725 US Highway 98 S Ste 102
Lakeland, FL 33812-4334
Phone
(863) 646-9663
Fax
(863) 646-8664
NPI assigned
Jun 9, 2017
Last updated
Jun 9, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
INHEALTH MD ALLIANCE LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 9, 2017

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

Authorized official

Name
Mrs. Patricia Pichardo
Title
Coo
Phone
(407) 845-0330

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X Primary

Addresses

Primary practice location

4725 US Highway 98 S Ste 102
Lakeland, FL 33812-4334

Mailing address

6675 Westwood Blvd Ste 475
Orlando, FL 32821-6027
Phone (407) 845-0330

Other names 1

  • IMA South Lakeland Dispensary Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Medical Home Alliance LLC37 organizations share this tax ID, including this one
Part of
Medical Home Alliance LLC

Other organizations with this tax ID 36

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

View all 36

Locations

4725 US Highway 98 S
Ste 102
Lakeland, FL 33812
Phone (863) 533-1100

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1496966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1496966400000",
    "number": "1386173573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6675 WESTWOOD BLVD STE 475",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328216027",
            "telephone_number": "407-845-0330",
            "fax_number": "888-972-1752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4725 US HIGHWAY 98 S STE 102",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338124334",
            "telephone_number": "863-646-9663",
            "fax_number": "863-646-8664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL HOME ALLIANCE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INHEALTH MD ALLIANCE LLC",
        "enumeration_date": "2017-06-09",
        "last_updated": "2017-06-09",
        "status": "A",
        "authorized_official_last_name": "PICHARDO",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "407-845-0330",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IMA South Lakeland Dispensary",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.