Healthcare Provider Details
I. General information
NPI: 1043315377
Provider Name (Legal Business Name): CITRUS HILLS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 09/13/2006
Last Update Date: 08/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2484 N ESSEX AVE
HERNANDO FL
34442
US
IV. Provider business mailing address
2484 N ESSEX AVE
HERNANDO FL
34442
US
V. Phone/Fax
- Phone: 352-746-1358
- Fax: 352-746-1972
- Phone: 352-746-1358
- Fax: 352-746-1972
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208VP0000X |
| Taxonomy | Pain Medicine Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
BRADLEY
H
RUBEN
Title or Position: PRESIDENT OWNER
Credential: DO
Phone: 352-746-1358