Provider Demographics
NPI:1205874716
Name:UPSTATE PSYCHIATRIC ASSOCIATES PA
Entity type:Organization
Organization Name:UPSTATE PSYCHIATRIC ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:CASTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-585-0328
Mailing Address - Street 1:1330 BOILING SPRINGS RD
Mailing Address - Street 2:SUITE 2800
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-4201
Mailing Address - Country:US
Mailing Address - Phone:864-585-0328
Mailing Address - Fax:864-585-8808
Practice Address - Street 1:1330 BOILING SPRINGS RD
Practice Address - Street 2:SUITE 2800
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-4201
Practice Address - Country:US
Practice Address - Phone:864-585-0328
Practice Address - Fax:864-585-8808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2012-01-31
Deactivation Date:2008-06-03
Deactivation Code:
Reactivation Date:2008-06-17
Provider Licenses
StateLicense IDTaxonomies
SC63552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC6P0224Medicaid
SC3788Medicare ID - Type Unspecified
SC6P0224Medicaid