Provider Demographics
NPI:1316192263
Name:CITADEL MEDICAL SERVICES INC
Entity Type:Organization
Organization Name:CITADEL MEDICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:C
Authorized Official - Last Name:RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-446-3895
Mailing Address - Street 1:3934 SW 8TH ST
Mailing Address - Street 2:#307
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2949
Mailing Address - Country:US
Mailing Address - Phone:305-446-3895
Mailing Address - Fax:305-446-3897
Practice Address - Street 1:3934 SW 8TH ST
Practice Address - Street 2:#307
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2949
Practice Address - Country:US
Practice Address - Phone:305-446-3895
Practice Address - Fax:305-446-3897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty