Provider Demographics
NPI:1750544706
Name:CITRUS FAMILY MEDICAL CENTER LLC
Entity type:Organization
Organization Name:CITRUS FAMILY MEDICAL CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GAUCHAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-348-0990
Mailing Address - Street 1:1485 LEGENDS BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33896
Mailing Address - Country:US
Mailing Address - Phone:863-537-8000
Mailing Address - Fax:
Practice Address - Street 1:1485 LEGENDS BOULEVARD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33896
Practice Address - Country:US
Practice Address - Phone:863-537-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care