Healthcare Provider Details

I. General information

NPI: 1598842221
Provider Name (Legal Business Name): CITRUS BONE & JOINT SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3264 W AUDUBON PARK PATH
LECANTO FL
34461-8450
US

IV. Provider business mailing address

3264 W AUDUBON PARK PATH
LECANTO FL
34461-8450
US

V. Phone/Fax

Practice location:
  • Phone: 352-746-0654
  • Fax:
Mailing address:
  • Phone: 352-746-0654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN C COUCH
Title or Position: TREASURER
Credential:
Phone: 352-746-0654