| NPI | 1063858538 |
|---|---|
| Doing Business As | LAKE MIRIAM CAMPUS |
| Entity Type | Organization |
| Authorized Contact | LANCE GREEN VP/CFO 863-687-1100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine |
| 208D00000X General Practice | |
| 363LF0000X Nurse Practitioner, Family | |
| 207Q00000X Family Medicine | |
| 207R00000X Internal Medicine | |
| Enumeration Date | 2013-05-10 |
| Last Update Date | 2023-01-24 |