Provider Demographics
NPI:1720672074
Name:CARROLLTON SPRINGS PHYSICIAN GROUP
Entity type:Organization
Organization Name:CARROLLTON SPRINGS PHYSICIAN GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAMATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-634-1270
Mailing Address - Street 1:101 S 5TH ST STE 3850
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3127
Mailing Address - Country:US
Mailing Address - Phone:412-588-3546
Mailing Address - Fax:
Practice Address - Street 1:1820 N LAKE FOREST DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-7651
Practice Address - Country:US
Practice Address - Phone:469-634-1270
Practice Address - Fax:469-634-1271
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARROLLTON SPRINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty