Provider Demographics
NPI:1932306495
Name:CITRUS NEUROSCIENCE INSTITUTE P.A
Entity Type:Organization
Organization Name:CITRUS NEUROSCIENCE INSTITUTE P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BHARAT
Authorized Official - Middle Name:V
Authorized Official - Last Name:PARKIH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-422-2680
Mailing Address - Street 1:5596 W NORVELL BRYANT HWY
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-7572
Mailing Address - Country:US
Mailing Address - Phone:352-795-6999
Mailing Address - Fax:352-795-0154
Practice Address - Street 1:657 W BRITAIN ST
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:FL
Practice Address - Zip Code:34442-8323
Practice Address - Country:US
Practice Address - Phone:352-422-2680
Practice Address - Fax:352-527-0368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044794174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21534Medicare UPIN