| St Lukes Regional Health Care Plc | |
|
6030 S Florida Av, Ste 110 St Lukes Regional Health Care Plc Lakeland FL 33813 | |
| (863) 644-9800 | |
| (863) 644-9822 |
| Full Name | St Lukes Regional Health Care Plc |
|---|---|
| Speciality | Family Medicine |
| Location | 6030 S Florida Av, Ste 110, Lakeland, Florida |
| Authorized Official Name and Position | Traci H Martin (OPERATIONS MANAGER) |
| Authorized Official Contact | 8636449800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St Lukes Regional Health Care Plc Po Box 7396 St Lukes Regional Health Care Plc Lakeland FL 33807-7396 Ph: (863) 644-9800 | St Lukes Regional Health Care Plc 6030 S Florida Av, Ste 110 St Lukes Regional Health Care Plc Lakeland FL 33813 Ph: (863) 644-9800 |
| NPI Number | 1184755183 |
|---|---|
| Provider Enumeration Date | 03/08/2007 |
| Last Update Date | 07/19/2019 |
| Medicare PECOS PAC ID | 7911094727 |
|---|---|
| Medicare Enrollment ID | O20071025000527 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184755183 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ME82770 (Florida) | Primary |
| Provider Name | Youssef B Ghaly |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770580334 PECOS PAC ID: 1658476809 Enrollment ID: I20070417000120 |
| Provider Name | Lori Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558731158 PECOS PAC ID: 5496059867 Enrollment ID: I20160204001180 |
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