Provider Demographics
NPI:1528116027
Name:CITRUS NEPHROLOGY ASSOCIATES INC
Entity type:Organization
Organization Name:CITRUS NEPHROLOGY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PADMA
Authorized Official - Middle Name:V
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-795-1415
Mailing Address - Street 1:7415 W GULF TO LAKE HWY
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-7834
Mailing Address - Country:US
Mailing Address - Phone:352-795-1415
Mailing Address - Fax:352-795-6801
Practice Address - Street 1:7415 W GULF TO LAKE HWY
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-7834
Practice Address - Country:US
Practice Address - Phone:352-795-1415
Practice Address - Fax:352-795-6801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250407300Medicaid
FLG18193Medicare UPIN
FLC58005Medicare UPIN
FL40434Medicare ID - Type Unspecified