1245279751 NPI number — DR. JOHN B CASTERLINE MD

Table of content: DR. JOHN B CASTERLINE MD (NPI 1245279751)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245279751 NPI number — DR. JOHN B CASTERLINE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTERLINE
Provider First Name:
JOHN
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
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:
1245279751
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2871 ACTON ROAD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35243-2560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-939-0023
Provider Business Mailing Address Fax Number:
205-939-4180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2871 ACTON ROAD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35243-2560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-716-6900
Provider Business Practice Location Address Fax Number:
205-939-0293
Provider Enumeration Date:
06/06/2006

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: 208G00000X , with the licence number:  17130 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000034643 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 780001016 . This is a "PALMETTO GBA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 009985610 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051034643 . This is a "BLUE CROSS - 2660 10TH AV" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009978860 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051506125 . This is a "BLUE CROSS - 48 MED PARK" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051507478 . This is a "BLUE CROSS - 860 MONT RD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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