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RRC100157-06 LAKELAND REGIONAL MED CTR (Terminated)
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Main Details
Name
LAKELAND REGIONAL MED CTR
Subdivision Name
Grasslands Campus - Infusion Therapy Center - Infusion Therapy
Type
Rural Referral Center
Rural
No
340B ID
RRC100157-06
Medicare Provider Number
100157
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/10/2018
Participating Start Date
7/1/2018
Participating Approval Date
5/7/2018
Last Recertification Date
8/28/2019
Termination Date
Termination Reason
1/1/2020
Change of covered entity type (non-hospital)
Contacts
Authorizing Official
Lakeland Regional Medical Center, Inc.
Lance Green, EVP/Chief Financial Officer
(863) 687-1100 Ext: 5225
Primary Contact
Lakeland Regional Medical Center, Inc.
Jason Alan McNeil, AVP/Finance
(863) 687-1100 Ext: 1011
Addresses
Street Address
3030 Harden Blvd
Lakeland, FL 33803
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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