Provider Demographics
NPI:1043315377
Name:CITRUS HILLS MEDICAL CENTER
Entity type:Organization
Organization Name:CITRUS HILLS MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:H
Authorized Official - Last Name:RUBEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:352-746-1358
Mailing Address - Street 1:2484 N ESSEX AVE
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:FL
Mailing Address - Zip Code:34442
Mailing Address - Country:US
Mailing Address - Phone:352-746-1358
Mailing Address - Fax:352-746-1972
Practice Address - Street 1:2484 N ESSEX AVE
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:FL
Practice Address - Zip Code:34442
Practice Address - Country:US
Practice Address - Phone:352-746-1358
Practice Address - Fax:352-746-1972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3445Medicare ID - Type Unspecified