Provider Demographics
NPI:1922612977
Name:CASTLE HILLS MEDICAL GROUP
Entity Type:Organization
Organization Name:CASTLE HILLS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CIEF LEGAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RADHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVITALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-403-9595
Mailing Address - Street 1:4343 N JOSEY LN
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4603
Mailing Address - Country:US
Mailing Address - Phone:310-403-9595
Mailing Address - Fax:
Practice Address - Street 1:4343 N JOSEY LN
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4603
Practice Address - Country:US
Practice Address - Phone:310-403-9595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANA HEALTHCARE CARROLLTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-06
Last Update Date:2020-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty