Provider Demographics
NPI:1588849426
Name:JOHN E CASTLE
Entity type:Organization
Organization Name:JOHN E CASTLE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:CASTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:541-471-3668
Mailing Address - Street 1:1227 NE 7TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1430
Mailing Address - Country:US
Mailing Address - Phone:541-471-3668
Mailing Address - Fax:541-471-4814
Practice Address - Street 1:1227 NE 7TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1430
Practice Address - Country:US
Practice Address - Phone:541-471-3668
Practice Address - Fax:541-471-4814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00246332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0984130001Medicare NSC