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

Table of content: MARK E HAGAN R.PH. (NPI 1508291725)

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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