Basic Information
| Provider Information | |||||||||
| NPI: | 1417987769 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CASTLETON SURGICAL GROUP, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8040 CLEARVISTA PKWY | ||||||||
| Address2: | SUITE #240 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462565630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176215450 | ||||||||
| FaxNumber: | 3176215453 | ||||||||
| Practice Location | |||||||||
| Address1: | 8040 CLEARVISTA PKWY | ||||||||
| Address2: | SUITE #240 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462565630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176215450 | ||||||||
| FaxNumber: | 3176215453 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 04/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | BAUGHMAN | ||||||||
| AuthorizedOfficialFirstName: | RONALD | ||||||||
| AuthorizedOfficialMiddleName: | D. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3176215450 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 01033626A | IN | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 100176920A | 05 | IN | MEDICAID | CL0542 | 01 | IN | MEDICARE RAILROAD | OTHER |