Provider Demographics
NPI:1821068289
Name:CITRUS UROLOGY CENTER, INC.
Entity Type:Organization
Organization Name:CITRUS UROLOGY CENTER, INC.
Other - Org Name:LECANTO SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-527-0102
Mailing Address - Street 1:3075 W GULF TO LAKE HWY
Mailing Address - Street 2:PO BOX 1420
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461-9228
Mailing Address - Country:US
Mailing Address - Phone:352-527-0102
Mailing Address - Fax:352-527-8863
Practice Address - Street 1:3075 W GULF TO LAKE HWY
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-9228
Practice Address - Country:US
Practice Address - Phone:352-527-0102
Practice Address - Fax:352-527-8863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1062261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL079242000Medicaid
FLF1291Medicare ID - Type Unspecified