Provider Demographics
NPI:1942224308
Name:CITRUS ORTHOPEDICS
Entity Type:Organization
Organization Name:CITRUS ORTHOPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:HOPE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-641-1508
Mailing Address - Street 1:113 MILLER MAC RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-2609
Mailing Address - Country:US
Mailing Address - Phone:813-641-1508
Mailing Address - Fax:
Practice Address - Street 1:113 B MILLER MAC RD
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-2609
Practice Address - Country:US
Practice Address - Phone:813-641-1508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5750990001Medicare NSC