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General NPI Number Information
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NPI Number | 1598082158
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Entity Type | Organization
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Legal Business Name | CASTLEVIEW PHYSICIAN PRACTICES, LLC
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Dates
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Enumeration Date | 04/22/2010
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Last Update Date | 04/22/2010
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Provider Practice Location Address
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Address Line | 90 WEST MAIN STREET
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City | CASTLE DALE
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State | UT
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Zip | 84513
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Country | US
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Telephone | 435-381-2305
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Fax | 435-381-5010
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Provider Business Mailing Address
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Address Line | PO BOX 607
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City | CASTLE DALE
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State | UT
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Zip | 84513-0607
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Country | US
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Telephone | 435-381-2305
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Fax | 435-381-5010
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JESS N JUDY
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Credential |
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Telephone | 615-372-8508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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