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PALM MEDICAL CENTER LAKELAND LLC
NPI 1073249348
General Practice in Tampa, FL

Active since July 28, 2022CLIA 10D2172340 · Waiver
11017 N DALE MABRY HWY STE B, TAMPA, FL 33618(813) 337-7402(813) 461-6462 Get Directions Write a Review

NPPES record last updated: July 28, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Palm Medical Center Lakeland Llc NPPES

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

PALM MEDICAL CENTER LAKELAND LLC (NPI 1073249348) is a healthcare organization registered as a general practice in Tampa, Florida and active in the NPI registry since July 2022. The organization holds a CLIA Waiver certificate valid through September 19, 2027 and lists Santiago Moises Martin, President Of Center Operations, as its authorized official.

NPPES Registry Identity

NPI1073249348
Entity TypeOrganization
Primary Taxonomy208D00000X
Legal Business NamePALM MEDICAL CENTER LAKELAND LLC
Location Address11017 N DALE MABRY HWY STE BTampa, FL 33618-3873
Mailing Address2600 S Douglas Rd Ste 308Coral Gables, FL 33134-6134 · (813) 538-7880 · Fax (305) 442-1198
Phone(813) 337-7402
Fax(813) 461-6462
Organization SubpartNo
Authorized OfficialSantiago Moises MartinPresident Of Center Operations · (305) 913-9441
Enumeration DateJuly 28, 2022
NPPES CertifiedJuly 28, 2022
✔ NPI 1073249348 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
Also ListedClinic/CenterTaxonomy 261Q00000X
11017 N DALE MABRY HWY STE B, Tampa, FL 33618
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Other Identifiers 1

Medicaid016289500FL

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 10D2172340

Palm Medical Centers · Tampa, FL
Active · expires Sep 19, 2027
CLIA Number10D2172340
Laboratory TypePhysician Office
Certificate Effective DateSeptember 20, 2025
Certificate Expiration DateSeptember 19, 2027
Laboratory DirectorCesar Molano Murillo
Laboratory Phone(813) 337-7402
Laboratory LocationPalm Medical Centers11017 N Dale Mabry Hwy - Suite B, Tampa, FL 33618
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

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

MARIO E PROFET MD, RDMS, RDCS, RPVI
General Practice
11017 N DALE MABRY HWY STE B
TAMPA, FL 33618
Hillsborough County (813) 337-7402
DR PROFET HEALTH & WELLNESS CENTER LLC
General Practice
11017 N DALE MABRY HWY STE B
TAMPA, FL 33618
Hillsborough County (813) 337-7402
HEALTH HOLDINGS COMPANY LLC
Clinic/Center
11017 N DALE MABRY HWY STE B
TAMPA, FL 33618
Hillsborough County (813) 337-7402

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Palm Medical Center Lakeland LLC's NPI number?

The NPI number for Palm Medical Center Lakeland LLC is 1073249348. It was assigned to this organization in the NPPES registry on July 28, 2022.

Where is Palm Medical Center Lakeland LLC located?

Palm Medical Center Lakeland LLC is located at 11017 N Dale Mabry Hwy Ste B, Tampa, FL 33618. The listed phone number is (813) 337-7402.

What is Palm Medical Center Lakeland LLC's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Does Palm Medical Center Lakeland LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D2172340) is associated with this NPI, valid through September 19, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Palm Medical Center Lakeland LLC accept?

Health plans from Florida Blue (BlueCross BlueShield FL) and Florida Blue HMO (a BlueCross BlueShield FL company) list Palm Medical Center Lakeland LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Palm Medical Center Lakeland LLC was last updated on July 28, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.