Provider Demographics
NPI:1083346258
Name:PALMETTO ASSISTED LIVING MEDICAL GROUP PC
Entity Type:Organization
Organization Name:PALMETTO ASSISTED LIVING MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-994-1711
Mailing Address - Street 1:PO BOX 2029
Mailing Address - Street 2:
Mailing Address - City:BRYSON CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28713-5029
Mailing Address - Country:US
Mailing Address - Phone:828-735-2822
Mailing Address - Fax:828-538-4549
Practice Address - Street 1:25 CHINA COCKLE WAY
Practice Address - Street 2:
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-1907
Practice Address - Country:US
Practice Address - Phone:717-994-1711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-27
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5917260Medicaid