Provider Demographics
NPI:1487981262
Name:LAKELAND VOLUNTEERS IN MEDICINE
Entity type:Organization
Organization Name:LAKELAND VOLUNTEERS IN MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTUVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:863-688-5846
Mailing Address - Street 1:1021 LAKELAND HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-4672
Mailing Address - Country:US
Mailing Address - Phone:863-688-5846
Mailing Address - Fax:863-688-5846
Practice Address - Street 1:1021 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-4672
Practice Address - Country:US
Practice Address - Phone:863-688-5846
Practice Address - Fax:863-688-5846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL695832261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health