Healthcare Provider Details

I. General information

NPI: 1013364884
Provider Name (Legal Business Name): CASTLEVIEW PHYSICIAN PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2016
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 E 100 N SUITE 4
PRICE UT
84501-2640
US

IV. Provider business mailing address

330 SEVEN SPRINGS WAY ATTEN: PROVIDER ENROLLMENT
BRENTWOOD TN
37027-5098
US

V. Phone/Fax

Practice location:
  • Phone: 435-637-7551
  • Fax: 435-636-0499
Mailing address:
  • Phone: 615-920-7000
  • Fax: 615-920-8775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLOTTE LAWRENCE
Title or Position: SECRETARY
Credential:
Phone: 615-920-7000