Provider Demographics
NPI:1154868693
Name:LEESBURG REGIONAL MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:LEESBURG REGIONAL MEDICAL CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-323-5002
Mailing Address - Street 1:600 E DIXIE AVE
Mailing Address - Street 2:ATTN: ALEX CHANG, ADMINISTRATION
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-5925
Mailing Address - Country:US
Mailing Address - Phone:352-323-4267
Mailing Address - Fax:352-323-5039
Practice Address - Street 1:700 N PALMETTO ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-4419
Practice Address - Country:US
Practice Address - Phone:352-323-5007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit