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General NPI Number Information
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NPI Number | 1073099461
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Entity Type | Organization
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Legal Business Name | CITRUS MULTI CARE LLC
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Dates
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Enumeration Date | 07/18/2018
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Last Update Date | 11/05/2021
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Provider Practice Location Address
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Address Line | 255 SE 7TH AVE STE 1
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City | CRYSTAL RIVER
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State | FL
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Zip | 34429-4848
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Country | US
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Telephone | 352-794-6385
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Fax |
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Provider Business Mailing Address
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Address Line | 255 SE 7TH AVE STE 3
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City | CRYSTAL RIVER
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State | FL
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Zip | 34429-4848
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Country | US
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Telephone | 352-302-2223
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRANDIE UNDERWOOD
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Credential |
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Telephone | 352-302-2223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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