1184755183 NPI number — ST LUKES REGIONAL HEALTH CARE PLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184755183 NPI number — ST LUKES REGIONAL HEALTH CARE PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST LUKES REGIONAL HEALTH CARE PLC
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:
Provider Other Organization Name Type Code:
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:
1184755183
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7396
Provider Second Line Business Mailing Address:
ST LUKES REGIONAL HEALTH CARE PLC
Provider Business Mailing Address City Name:
LAKELAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33807-7396
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-644-9800
Provider Business Mailing Address Fax Number:
863-644-9822

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6030 S FLORIDA AV, STE 110
Provider Second Line Business Practice Location Address:
ST LUKES REGIONAL HEALTH CARE PLC
Provider Business Practice Location Address City Name:
LAKELAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-644-9800
Provider Business Practice Location Address Fax Number:
863-644-9822
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
TRACI
Authorized Official Middle Name:
H
Authorized Official Title or Position:
OPERATIONS MANAGER
Authorized Official Telephone Number:
863-644-9800

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  ME82770 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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