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General NPI Number Information
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NPI Number | 1437552858
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Entity Type | Organization
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Legal Business Name | CITRUS SPECIALTY GROUP, INC
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Dates
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Enumeration Date | 09/30/2014
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Last Update Date | 10/21/2020
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Provider Practice Location Address
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Address Line | 403 W HIGHLAND BLVD
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City | INVERNESS
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State | FL
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Zip | 34452-4717
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Country | US
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Telephone | 352-726-3646
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Fax | 352-726-0079
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Provider Business Mailing Address
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Address Line | 2000 HEALTH PARK DR
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City | BRENTWOOD
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State | TN
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Zip | 37027-4525
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Country | US
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Telephone | 615-372-7600
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Fax | 866-346-1426
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Authorized Official
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Title or Position | VICE PRESIDENT/AO
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Name | WILLIAM TEDRICK JOHNSON
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Credential |
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Telephone | 615-372-3375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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