Provider Demographics
NPI:1750374906
Name:CARUSO MEDICAL CENTER INC
Entity type:Organization
Organization Name:CARUSO MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARUSO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:863-471-3344
Mailing Address - Street 1:3324 COMMERCE CENTER LN
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-5542
Mailing Address - Country:US
Mailing Address - Phone:863-471-3344
Mailing Address - Fax:863-471-1896
Practice Address - Street 1:3324 COMMERCE CENTER LN
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-5542
Practice Address - Country:US
Practice Address - Phone:863-471-3344
Practice Address - Fax:863-471-1896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA0003689363AM0700X
FLPT0016172225100000X
FLOS0004638208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82597OtherBCBS OF FL
FLK0523Medicare ID - Type Unspecified
FL82597OtherBCBS OF FL
FL5398680001Medicare NSC