Provider Demographics
NPI:1003834508
Name:CITRUS MEMORIAL HEALTH FOUNDATION INC
Entity Type:Organization
Organization Name:CITRUS MEMORIAL HEALTH FOUNDATION INC
Other - Org Name:CITRUS MEMORIAL HEALTH SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BEATY
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:352-344-7650
Mailing Address - Street 1:502 W HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4720
Mailing Address - Country:US
Mailing Address - Phone:352-344-6481
Mailing Address - Fax:352-344-3920
Practice Address - Street 1:502 W HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4720
Practice Address - Country:US
Practice Address - Phone:352-344-6481
Practice Address - Fax:352-344-3920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4233282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL544OtherFL BLUE CROSS BLUE SHIELD
FL010219900Medicaid
FL00285CMedicare PIN
FL00285AMedicare PIN
FL00285EMedicare PIN
FL544OtherFL BLUE CROSS BLUE SHIELD
FL00285Medicare PIN
FL10-0023Medicare ID - Type Unspecified
FL010219900Medicaid
FL00285HMedicare PIN
FL00285JMedicare PIN