Provider Demographics
NPI:1427358621
Name:CITRUS MEMORIAL HEALTH FOUNDATION INC
Entity Type:Organization
Organization Name:CITRUS MEMORIAL HEALTH FOUNDATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BEATY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-344-7650
Mailing Address - Street 1:123 S SEMINOLE AVE
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4735
Mailing Address - Country:US
Mailing Address - Phone:352-344-6481
Mailing Address - Fax:352-344-3920
Practice Address - Street 1:131 S CITRUS AVE
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4701
Practice Address - Country:US
Practice Address - Phone:352-344-6930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00285AMedicare PIN