Provider Demographics
NPI:1952419608
Name:CASTLETON FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:CASTLETON FAMILY PRACTICE LLC
Other - Org Name:CASTLETON FAMILY PRACTICE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:EMMIEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAY-ANDRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-748-5456
Mailing Address - Street 1:210 JUPITER LAKES BOULEVARD
Mailing Address - Street 2:BUILDING 3000, SUITE 102
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7831
Mailing Address - Country:US
Mailing Address - Phone:561-748-5456
Mailing Address - Fax:561-748-5460
Practice Address - Street 1:210 JUPITER LAKES BOULEVARD
Practice Address - Street 2:BUILDING 3000, SUITE 102
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7831
Practice Address - Country:US
Practice Address - Phone:561-748-5456
Practice Address - Fax:561-748-5460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care