Provider Demographics
NPI:1780741983
Name:LEESBURG REGIONAL MEDICAL CENTER INC
Entity type:Organization
Organization Name:LEESBURG REGIONAL MEDICAL CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:B
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-323-5001
Mailing Address - Street 1:600 E. DIXIE AVENUE
Mailing Address - Street 2:ATTN: REIMBURSEMENT DEPT.
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-5994
Mailing Address - Country:US
Mailing Address - Phone:352-323-5380
Mailing Address - Fax:352-315-5384
Practice Address - Street 1:600 E DIXIE AVE
Practice Address - Street 2:OUTPATIENT PHARMACY ROOM 1046
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5925
Practice Address - Country:US
Practice Address - Phone:352-323-5384
Practice Address - Fax:352-315-3679
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEESBURG REGIONAL MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-03
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10-29594OtherNABP
FL10-29594OtherNABP