| Organization Name: | VERIMED HEALTH GROUP LAKELAND LLC |
| NPI Number: | 1013321793 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PAMELA RUESCH (ADMINISTRATOR) |
| Mailing Address: | 1417 Lakeland Hills Blvd Suite 204 Lakeland |
| State: | FL US |
| Postal Code: | 338053200 |
| Phone Number: | 8134155038 |
| Fax Number: | |
| NPI Enumeration Date: | 06/20/2014 |
| NPI Last Update Date: | 07/28/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |