Provider Demographics
NPI:1104851823
Name:CASTLE ORTHOPAEDICS & SPORTS MEDICINE, S.C.
Entity Type:Organization
Organization Name:CASTLE ORTHOPAEDICS & SPORTS MEDICINE, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WAEGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-978-3800
Mailing Address - Street 1:2111 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504
Mailing Address - Country:US
Mailing Address - Phone:630-978-3800
Mailing Address - Fax:630-862-3086
Practice Address - Street 1:2111 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504
Practice Address - Country:US
Practice Address - Phone:630-978-3800
Practice Address - Fax:630-862-3086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042005445174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036055572Medicaid
ILCH6948Medicare PIN
IL908730Medicare PIN
ILCF4193Medicare PIN
IL426940Medicare PIN
IL036055572Medicaid
IL0427850001Medicare NSC