Provider Demographics
NPI:1093936932
Name:CASTILE COMMUNITY MEDICAL CENTER
Entity Type:Organization
Organization Name:CASTILE COMMUNITY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SCHIERER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:585-493-0505
Mailing Address - Street 1:5596 ROUTE 19A
Mailing Address - Street 2:CASTILE COMMUNITY MEDICAL CENTER
Mailing Address - City:CASTILE
Mailing Address - State:NY
Mailing Address - Zip Code:14427-0505
Mailing Address - Country:US
Mailing Address - Phone:585-493-2587
Mailing Address - Fax:585-493-5580
Practice Address - Street 1:5596 ROUTE 19A
Practice Address - Street 2:
Practice Address - City:CASTILE
Practice Address - State:NY
Practice Address - Zip Code:14427-0505
Practice Address - Country:US
Practice Address - Phone:585-493-2587
Practice Address - Fax:585-493-5580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177372207Q00000X
NY0022201207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH353OtherPREFERRED CARE
NYP010177372OtherBLUE CHOICE
NY01139986Medicaid
000560354003OtherCOMMUNITY BLUE
0102974OtherIPA
00010158803OtherUNIVERA
9512044OtherINDEPENDENT HEALTH
NYP020177372OtherEXCELLUS BCBS
NYP020177372OtherEXCELLUS BCBS
MDH353OtherPREFERRED CARE