Healthcare Provider Details

I. General information

NPI: 1821068289
Provider Name (Legal Business Name): CITRUS UROLOGY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 05/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 W GULF TO LAKE HWY
LECANTO FL
34461-9228
US

IV. Provider business mailing address

3075 W GULF TO LAKE HWY PO BOX 1420
LECANTO FL
34461-9228
US

V. Phone/Fax

Practice location:
  • Phone: 352-527-0102
  • Fax: 352-527-8863
Mailing address:
  • Phone: 352-527-0102
  • Fax: 352-527-8863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1062
License Number StateFL

VIII. Authorized Official

Name: MS. LAYNE LOWREY
Title or Position: ADMINISTRATOR
Credential:
Phone: 352-527-0102