Provider Demographics
NPI:1912258989
Name:MIDSTATE SKIN INSTITUTE, LLC
Entity Type:Organization
Organization Name:MIDSTATE SKIN INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAUTHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-512-0092
Mailing Address - Street 1:1740 SE 18TH ST STE 1102
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5447
Mailing Address - Country:US
Mailing Address - Phone:352-512-0092
Mailing Address - Fax:352-512-0093
Practice Address - Street 1:1740 SE 18TH ST STE 1102
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5447
Practice Address - Country:US
Practice Address - Phone:352-512-0092
Practice Address - Fax:352-512-0093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-30
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME112254207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty