Provider Demographics
NPI:1407125362
Name:CASTLEVIEW PHYSICIAN PRACTICES, LLC
Entity Type:Organization
Organization Name:CASTLEVIEW PHYSICIAN PRACTICES, LLC
Other - Org Name:EASTERN UTAH PHYSICAL MEDICINE & PAIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JESS
Authorized Official - Middle Name:
Authorized Official - Last Name:JUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-8508
Mailing Address - Street 1:945 W HOSPITAL DR
Mailing Address - Street 2:SUITE # 4
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-4214
Mailing Address - Country:US
Mailing Address - Phone:435-637-7246
Mailing Address - Fax:435-637-7247
Practice Address - Street 1:945 W HOSPITAL DR
Practice Address - Street 2:SUITE # 4
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-4214
Practice Address - Country:US
Practice Address - Phone:435-637-7246
Practice Address - Fax:435-637-7247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty