Provider Demographics
NPI:1821060401
Name:CITRUS UROLOGY ASSOCIATES P A
Entity Type:Organization
Organization Name:CITRUS UROLOGY ASSOCIATES P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PARESH
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-628-7671
Mailing Address - Street 1:PO BOX 3087
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34447-3087
Mailing Address - Country:US
Mailing Address - Phone:352-628-7671
Mailing Address - Fax:352-628-9893
Practice Address - Street 1:3475 S SUNCOAST BLVD
Practice Address - Street 2:
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34448-2322
Practice Address - Country:US
Practice Address - Phone:352-628-7671
Practice Address - Fax:352-628-9893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10D0272423208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCI4845OtherRAILROAD MEDICARE
FL060476301Medicaid
FL98224OtherBLUE CROSS BLUE SHEILD
FLCI4845OtherRAILROAD MEDICARE