1. Home
  2. Directory
  3. Florida
  4. Wildwood
  5. Clinic Center
  6. NPI Profile

LAKEWOOD CCL, LLC
NPI 1922575802
Clinic/Center - Multi-Specialty in Wildwood, FL

Active since October 29, 2018CLIA 10D2167678 · Certificate of Compliance
5571 E SR 44 STE 501, WILDWOOD, FL 34785(352) 643-9070(352) 571-6787 Get Directions Write a Review

NPPES record last updated: October 29, 2018. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Lakewood Ccl, Llc NPPES

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

LAKEWOOD CCL, LLC (NPI 1922575802) is a healthcare organization registered as a multi-specialty in Wildwood, Florida and active in the NPI registry since October 2018. The organization holds a CLIA Certificate of Compliance certificate valid through January 16, 2028 and lists Jose A Rivera, Administrator, as its authorized official.

NPPES Registry Identity

NPI1922575802
Entity TypeOrganization
Primary Taxonomy261QM1300X
Legal Business NameLAKEWOOD CCL, LLC
Location Address5571 E SR 44 STE 501Wildwood, FL 34785-8282
Mailing Address5571 E Sr 44 Ste 501Wildwood, FL 34785-8282 · (352) 643-9070 · Fax (352) 571-6787
Phone(352) 643-9070
Fax(352) 571-6787
Organization SubpartNo
Authorized OfficialJose A RiveraAdministrator · (352) 643-9070
Enumeration DateOctober 29, 2018
✔ NPI 1922575802 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Multi-SpecialtyAmbulatory Health Care Facilities
Taxonomy Code261QM1300X
5571 E SR 44 STE 501, Wildwood, FL 34785
Open in Google Maps ↗

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 Compliance 10D2167678

Lakewood Ccl, LLC · Wildwood, FL
Active · expires Jan 16, 2028
CLIA Number10D2167678
Laboratory TypePhysician Office
Certificate Effective DateJanuary 17, 2026
Certificate Expiration DateJanuary 16, 2028
Laboratory DirectorVinod R. Miryala
Laboratory Phone(352) 643-9070
Laboratory LocationLakewood Ccl, LLC5571 E Sr 44 Suite 502, Wildwood, FL 34785
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES

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

LAKEWOOD ASC, LLC
Clinic/Center (Ambulatory Surgical)
5571 E SR 44 STE 501
WILDWOOD, FL 34785
Sumter County (352) 643-9080

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 Lakewood Ccl, LLC's NPI number?

The NPI number for Lakewood Ccl, LLC is 1922575802. It was assigned to this organization in the NPPES registry on October 29, 2018.

Where is Lakewood Ccl, LLC located?

Lakewood Ccl, LLC is located at 5571 E Sr 44 Ste 501, Wildwood, FL 34785. The listed phone number is (352) 643-9070.

What is Lakewood Ccl, LLC's specialty?

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

Does Lakewood Ccl, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 10D2167678) is associated with this NPI, valid through January 16, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Lakewood Ccl, LLC was last updated on October 29, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.