1518185529 NPI number — NVMS OF NORTH CAROLINA, LLC

Table of content: MICHAEL J. CASTILLO CNP (NPI 1811144884)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518185529 NPI number — NVMS OF NORTH CAROLINA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NVMS OF NORTH CAROLINA, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1518185529
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 BLUEGRASS COMMONS BLVD
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
HENDERSONVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37075-2732
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-826-1500
Provider Business Mailing Address Fax Number:
615-826-2321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 BLUEGRASS COMMONS BLVD
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
HENDERSONVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37075-2732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-826-1500
Provider Business Practice Location Address Fax Number:
615-826-2321
Provider Enumeration Date:
04/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCCRACKEN
Authorized Official First Name:
SEAN
Authorized Official Middle Name:
FRANKLYN
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
615-826-1500

Provider Taxonomy Codes

  • Taxonomy code: 246ZE0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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