Primary Medical Center of Lakeland, LLC

Primary specialty

Legal MedicineTaxonomy code 173000000X

License

ME27448 Issued in FL

Legal business name

PRIMARY MEDICAL CENTER OF LAKELAND, LLC

Practice address

1417 Lakeland Hills Blvd
Suite #106
Lakeland, FL 33805-3200

Phone

(863) 687-4575

Fax

(863) 616-1342

NPI assigned

May 31, 2006

Organization subpart

No

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

Authorized official

Name

Marc A Guerrier Jr., MD

Title

Manager Member

Phone

(863) 687-4575

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478563200000",
    "number": "1780621607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1417 LAKELAND HILLS BLVD",
            "address_2": "SUITE #106",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338053200",
            "telephone_number": "863-687-4575",
            "fax_number": "863-616-1342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1417 LAKELAND HILLS BLVD",
            "address_2": "SUITE #106",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338053200",
            "telephone_number": "863-687-4575",
            "fax_number": "863-616-1342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY MEDICAL CENTER OF LAKELAND, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-31",
        "last_updated": "2016-11-08",
        "status": "A",
        "authorized_official_last_name": "GUERRIER",
        "authorized_official_first_name": "MARC",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGER MEMBER",
        "authorized_official_telephone_number": "863-687-4575",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Legal Medicine",
            "state": "FL",
            "license": "ME27448",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Legal Medicine in Lakeland, FL
• Providers in Lakeland, FL by specialty
• Legal Medicine in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2016; 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.