Healthcare Provider Details

I. General information

NPI: 1639484504
Provider Name (Legal Business Name): CASTLEVIEW PHYSICIAN PRACTICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2010
Last Update Date: 08/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 N HOSPITAL DR SUITE # 4
PRICE UT
84501-4216
US

IV. Provider business mailing address

280 N HOSPITAL DR SUITE # 4
PRICE UT
84501-4216
US

V. Phone/Fax

Practice location:
  • Phone: 435-637-3584
  • Fax: 435-637-3587
Mailing address:
  • Phone: 435-637-3584
  • Fax: 435-637-3587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: JESS JUDY
Title or Position: PRESIDENT
Credential:
Phone: 615-372-8508