Healthcare Provider Details

I. General information

NPI: 1811283393
Provider Name (Legal Business Name): CASTLEVIEW PHYSICIAN PRACTICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 06/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 W HOSPITAL DR SUITE #1
PRICE UT
84501-4214
US

IV. Provider business mailing address

945 W HOSPITAL DR SUITE #1
PRICE UT
84501-4214
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 Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JESS JUDY
Title or Position: PRESIDENT
Credential:
Phone: 615-565-1544