1063490381 NPI number — DR. SANTIAGO SINGSON CASTILLO JR. MD

Table of content: DR. SANTIAGO SINGSON CASTILLO JR. MD (NPI 1063490381)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063490381 NPI number — DR. SANTIAGO SINGSON CASTILLO JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTILLO
Provider First Name:
SANTIAGO
Provider Middle Name:
SINGSON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063490381
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2857 MANLEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAUMEE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43537-9654
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-320-0504
Provider Business Mailing Address Fax Number:
419-868-1525

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3535 OLENTANGY RIVER ROAD
Provider Second Line Business Practice Location Address:
PATHOLOGY DEPARTMENT
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43214-3908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-566-4945
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/06/2006

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: 207ZP0102X , with the licence number:  35-060060 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2474755 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: NM009T91 . This is a "BC/BS" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 1811436000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 934663 . This is a "AHCCCS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 201050986 . This is a "PRESBYTERIAN HEALTH/SALUD" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 10020366 . This is a "LOVELACE HEALTH/SALUD" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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