Provider Demographics
NPI:1063719599
Name:LAKELAND COMMUNITY HOSPITAL
Entity type:Organization
Organization Name:LAKELAND COMMUNITY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:JAVA MEDICAL GROUP CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASHOKE 'BAPPA'
Authorized Official - Middle Name:
Authorized Official - Last Name:MUKHERJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-308-8800
Mailing Address - Street 1:42024 HIGHWAY 195
Mailing Address - Street 2:P.O. BOX 780
Mailing Address - City:HALEYVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35565
Mailing Address - Country:US
Mailing Address - Phone:205-486-5213
Mailing Address - Fax:205-485-7127
Practice Address - Street 1:42024 HWY 195
Practice Address - Street 2:
Practice Address - City:HALEYVILLE
Practice Address - State:AL
Practice Address - Zip Code:35565-7054
Practice Address - Country:US
Practice Address - Phone:205-485-7108
Practice Address - Fax:205-485-7127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontologyGroup - Multi-Specialty
No273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL01S125Medicare Oscar/Certification