Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Lakeland Regional Health Systems, Inc

Organization Family Medicine Physician · NPI 1063858538

Lakeland Regional Health Systems, Inc is a Family Medicine Physician in Lakeland, Florida. Licensed in Florida. Registered with an NPI since 2013.

Licensed in
FL
In the registry since
2013
Specialties on file
6
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

4710 S Florida Ave
Lakeland, FL 33813-2165
Phone: (863) 284-6800
Fax: (863) 284-6807
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Multi-Specialty Clinic/Center (primary) Taxonomy 261QM1300X (FL)
Family Medicine Physician Taxonomy 207Q00000X
Internal Medicine Physician Taxonomy 207R00000X
Geriatric Medicine (Internal Medicine) Physician Taxonomy 207RG0300X
General Practice Physician Taxonomy 208D00000X
Family Nurse Practitioner Taxonomy 363LF0000X

Record details

NPI number1063858538
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Lance Green — Vp/Cfo · (863) 687-1100
Other names Lake Miriam Campus
NPI enumeratedMay 10, 2013
Last updated in NPPESJanuary 24, 2023
Certification dateJanuary 24, 2023
Mailing address1324 Lakeland Hills Blvd, Managed Care Dept, Lakeland, FL 33805

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