Lake Wales Primary Care Center, LLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

LAKE WALES PRIMARY CARE CENTER, LLC

Practice address

1120 Carlton Ave
Suite 2300
Lake Wales, FL 33853-4348

Phone

(727) 251-1366

Fax

(813) 968-5306

NPI assigned

Jun 26, 2008

Organization subpart

Yes

Parent organization

MEDICAL CARE CENTERSAs reported in NPPES

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

Authorized official

Name

Miss Namrata A. Amin

Title

Chief Operating Officer

Phone

(727) 251-1366

Specialties & licenses 1

Addresses

Part of

Medical Care Centers LLC

Locations

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

{
    "created_epoch": "1214438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240790400000",
    "number": "1750543344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6916 W LINEBAUGH AVE",
            "address_2": "SUITE 101",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336255815",
            "telephone_number": "727-251-1366",
            "fax_number": "813-968-5306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 CARLTON AVE",
            "address_2": "SUITE 2300",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338534348",
            "telephone_number": "727-251-1366",
            "fax_number": "813-968-5306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE WALES PRIMARY CARE CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDICAL CARE CENTERS",
        "enumeration_date": "2008-06-26",
        "last_updated": "2009-04-27",
        "status": "A",
        "authorized_official_last_name": "AMIN",
        "authorized_official_first_name": "NAMRATA",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "727-251-1366",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lake Wales Medial Center
• Lake Wales Medical Imaging Center One, Inc
• Lake Wales Medical Walk in Clinic PA
• Lake Wales Operating Group LLC
• Lake Wales Physician Services, LLC
• Lake Wales SLC Opco LLC (The Club at Lakes Wales)
• Lake Wales SNF LLC
• Lake Wales Transit LLC
• Lake Wales Urology, LLC
• Lakeland Regional Health System, Inc

• Specialist in Lake Wales, FL
• Providers in Lake Wales, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2009; 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.