LAKE MIRIAM CAMPUS - NPI 1063858538 - Clinic/Center in Lakeland, FL

Q: What is Lakeland Regional Health Systems, Inc.'s specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Multi-Specialty, with taxonomy code 261QM1300X.

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About Lake Miriam Campus NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LAKE MIRIAM CAMPUS (NPI 1063858538) is a healthcare organization registered as a multi-specialty in Lakeland, Florida and active in the NPI registry since May 2013. The organization holds a CLIA Waiver certificate valid through April 15, 2027 and lists Lance Green, Vp/cfo, as its authorized official.

NPPES Registry Identity

NPI1063858538

Entity TypeOrganization

Primary Taxonomy261QM1300X

Legal Business NameLAKELAND REGIONAL HEALTH SYSTEMS, INC.

Location Address4710 S FLORIDA AVELakeland, FL 33813-2165

Mailing Address1324 Lakeland Hills Blvd, Managed Care DeptLakeland, FL 33805 · (863) 687-1100 · Fax (863) 630-6528

Phone(863) 284-6800

Fax(863) 284-6807

Organization SubpartNo

Authorized OfficialLance GreenVp/cfo · (863) 687-1100

Enumeration DateMay 10, 2013

Last NPPES UpdateJanuary 24, 20234 updates tracked since enumeration

NPPES CertifiedJanuary 24, 2023

✔ NPI 1063858538 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 6

★ Primary SpecialtyClinic/Center · Multi-SpecialtyAmbulatory Health Care Facilities

Taxonomy Code261QM1300X

Also ListedFamily MedicineTaxonomy 207Q00000X

Also ListedInternal MedicineTaxonomy 207R00000X

Also ListedInternal Medicine · Geriatric MedicineTaxonomy 207RG0300X

Also ListedGeneral PracticeTaxonomy 208D00000X

Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X

4710 S FLORIDA AVE, Lakeland, FL 33813

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Other Names 1

Doing Business AsLake Miriam Campus

Other Identifiers 1

Medicaid263421005FL

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Florida Blue (BlueCross BlueShield FL), Florida Blue HMO (a BlueCross BlueShield FL company).Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D0947587

Lakeland Regional Health · Lakeland, FL

Active · expires Apr 15, 2027

CLIA Number10D0947587

Laboratory TypePhysician Office

Certificate Effective DateApril 16, 2025

Certificate Expiration DateApril 15, 2027

Laboratory DirectorBrian J. Yoder

Laboratory Phone(863) 687-1436

Laboratory LocationLakeland Regional Health4710 South Florida Ave, Lakeland, FL 33813

CLIA data matches this NPI record on: Address Name

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 17

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MELANTHA AYE MD

Internal Medicine