Provider Demographics
NPI:1083678742
Name:CASTLE MEDICAL
Entity Type:Organization
Organization Name:CASTLE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:CASTLEBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-732-6189
Mailing Address - Street 1:690 COLLEGE ST
Mailing Address - Street 2:POST OFFICE BOX 56
Mailing Address - City:CUTHBERT
Mailing Address - State:GA
Mailing Address - Zip Code:39840-5552
Mailing Address - Country:US
Mailing Address - Phone:229-732-6189
Mailing Address - Fax:229-732-6192
Practice Address - Street 1:690 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:CUTHBERT
Practice Address - State:GA
Practice Address - Zip Code:39840-5552
Practice Address - Country:US
Practice Address - Phone:229-732-6189
Practice Address - Fax:229-732-6192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000745313AMedicaid
GA4060860001Medicare NSC