Healthcare Provider Details

I. General information

NPI: 1750374906
Provider Name (Legal Business Name): CARUSO MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3324 COMMERCE CENTER LN
SEBRING FL
33870-5542
US

IV. Provider business mailing address

3324 COMMERCE CENTER LN
SEBRING FL
33870-5542
US

V. Phone/Fax

Practice location:
  • Phone: 863-471-3344
  • Fax: 863-471-1896
Mailing address:
  • Phone: 863-471-3344
  • Fax: 863-471-1896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOS0004638
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT0016172
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA0003689
License Number StateFL

VIII. Authorized Official

Name: DR. JOHN R CARUSO
Title or Position: DO
Credential: DO
Phone: 863-471-3344