| Adventhealth Polk South Inc | |
|
410 S 11th St Lake Wales FL 33853-4203 | |
| (863) 676-1433 | |
| (863) 297-1867 |
| Full Name | Adventhealth Polk South Inc |
|---|---|
| Speciality | General Acute Care Hospital |
| Location | 410 S 11th St, Lake Wales, Florida |
| Authorized Official Name and Position | Alan Justin Hengesbach (CFO) |
| Authorized Official Contact | 8634192260 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Adventhealth Polk South Inc 410 S 11th St Lake Wales FL 33853-4203 Ph: (863) 676-1433 | Adventhealth Polk South Inc 410 S 11th St Lake Wales FL 33853-4203 Ph: (863) 676-1433 |
| NPI Number | 1053972760 |
|---|---|
| Provider Enumeration Date | 06/24/2019 |
| Last Update Date | 01/19/2024 |
| Certification Date | 01/19/2024 |
| Medicare PECOS PAC ID | 5092045369 |
|---|---|
| Medicare Enrollment ID | O20190930001761 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053972760 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | (* (Not Available)) | Secondary |
| 282N00000X | General Acute Care Hospital | (* (Not Available)) | Primary |
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