Provider Demographics
NPI:1386293215
Name:CITRUS SPINE INSTITUTE LLC
Entity type:Organization
Organization Name:CITRUS SPINE INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSTANTINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:TOUMBIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:352-794-6868
Mailing Address - Street 1:6099 W GULF TO LAKE HWY
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-8721
Mailing Address - Country:US
Mailing Address - Phone:352-794-6868
Mailing Address - Fax:352-794-6869
Practice Address - Street 1:1409 KINGSLEY AVE STE 9F
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4579
Practice Address - Country:US
Practice Address - Phone:904-579-3448
Practice Address - Fax:904-375-1761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty