Provider Demographics
NPI:1518978477
Name:CITRUS MEDICAL SUPPLIES, INC
Entity Type:Organization
Organization Name:CITRUS MEDICAL SUPPLIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAWFIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-795-2667
Mailing Address - Street 1:7562 W. GULF TO LAKE HWY
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429
Mailing Address - Country:US
Mailing Address - Phone:352-795-2667
Mailing Address - Fax:352-564-4222
Practice Address - Street 1:7562 W. GULF TO LAKE HWY
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429
Practice Address - Country:US
Practice Address - Phone:352-795-2667
Practice Address - Fax:352-564-4222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5418260001Medicare NSC