1720165327 NPI number — LAKELAND HOSPITAL ACQUISITION, LLC

Table of content: (NPI 1720165327)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720165327 NPI number — LAKELAND HOSPITAL ACQUISITION, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAKELAND HOSPITAL ACQUISITION, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LAKELAND BEHAVIORAL HEALTH SYSTEM
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720165327
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6100 TOWER CIR STE 1000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37067-1509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-861-6000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
440 SOUTH MARKET AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65806-2026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-865-5581
Provider Business Practice Location Address Fax Number:
417-865-5964
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FARLEY
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
VICE PRESIDENT & SECRETARY
Authorized Official Telephone Number:
615-861-6000

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X , with the licence number:  432-14 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 323P00000X , with the licence number: 000754769 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200371220A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 107192 . This is a "BC PROVIDER NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 118836125 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 011287901 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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