Provider Demographics
NPI:1891191953
Name:CASTLE MEDICAL, LLC
Entity type:Organization
Organization Name:CASTLE MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-486-7340
Mailing Address - Street 1:5700 HIGHLANDS PKWY SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-5142
Mailing Address - Country:US
Mailing Address - Phone:678-486-7340
Mailing Address - Fax:678-486-7350
Practice Address - Street 1:3705 W MEMORIAL RD
Practice Address - Street 2:SUITE 1406-1407
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1512
Practice Address - Country:US
Practice Address - Phone:678-486-7340
Practice Address - Fax:678-486-7350
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASTLE MEDICAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3512478144291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory