Provider Demographics
NPI:1598842221
Name:CITRUS BONE & JOINT SPECIALISTS
Entity Type:Organization
Organization Name:CITRUS BONE & JOINT SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:COUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-746-0654
Mailing Address - Street 1:3264 W AUDUBON PARK PATH
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461-8450
Mailing Address - Country:US
Mailing Address - Phone:352-746-0654
Mailing Address - Fax:
Practice Address - Street 1:3264 W AUDUBON PARK PATH
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-8450
Practice Address - Country:US
Practice Address - Phone:352-746-0654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7366Medicare ID - Type Unspecified