Provider Demographics
NPI:1679581003
Name:CAROLINA LITHOTRIPSY, A LIMITED PARTNERSHIP
Entity type:Organization
Organization Name:CAROLINA LITHOTRIPSY, A LIMITED PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PAYER RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LATANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-544-5939
Mailing Address - Street 1:1990 STEAM WAY STE A102
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-2233
Mailing Address - Country:US
Mailing Address - Phone:877-465-4845
Mailing Address - Fax:512-872-5105
Practice Address - Street 1:1990 STEAM WAY STE A102
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-2233
Practice Address - Country:US
Practice Address - Phone:877-465-4845
Practice Address - Fax:512-872-5105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QL0400XAmbulatory Health Care FacilitiesClinic/CenterLithotripsy
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0006POtherBC
NC7901749Medicaid