LAKE WALES CLINIC CORP NPI 1457350027

NPI Information

NPI: 1457350027
Provider Name: LAKE WALES CLINIC CORP
Classification: Family Medicine - 207Q00000X
Entity Type: Organization
Address:
410 S 11TH ST
LAKE WALES, FL
ZIP 33853
Phone: (863) 676-1433
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LAKE WALES CLINIC CORP is a family medicine in Lake Wales, FL. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. LAKE WALES CLINIC CORP NPI is 1457350027. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

410 S 11TH ST
LAKE WALES, FL
ZIP 33853-203
Phone: (863) 676-1433

The provider's authorized official is James P Wright .
The authorized official title is Vp Physician Business Services and has the following contact phone number (615) 778-1502.

The enumeration date for this NPI number is 7/18/2005 and was last updated on 7/22/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	208600000X	Surgery		No
2	207R00000X	Internal Medicine		No
3	207RG0100X	Internal Medicine	Gastroenterology	No
4	207X00000X	Orthopaedic Surgery		No
5	208000000X	Pediatrics		No
6	2084N0600X	Psychiatry & Neurology	Clinical Neurophysiology	No
7	2084S0012X	Psychiatry & Neurology	Sleep Medicine	No
8	207Q00000X	Family Medicine		Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	26904200	MEDICAID	FLORIDA
2	74943	OTHER	FLORIDA	BCBS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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