1023085925 NPI number — SABRINA BENEFIELD CASTLE M.D.

Table of content: SABRINA BENEFIELD CASTLE M.D. (NPI 1023085925)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023085925 NPI number — SABRINA BENEFIELD CASTLE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTLE
Provider First Name:
SABRINA
Provider Middle Name:
BENEFIELD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BENEFIELD
Provider Other First Name:
SABRINA
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023085925
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 TURTLE CREEK DR.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONGVIEW
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-235-0701
Provider Business Mailing Address Fax Number:
903-381-7269

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2510 W. BERT KOUNS INDUSTRIAL LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-212-5000
Provider Business Practice Location Address Fax Number:
903-553-7751
Provider Enumeration Date:
03/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  L1613 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 165498003 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".