Basic Information
| Provider Information | |||||||||
| NPI: | 1043290422 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCASKILL | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 511 RUIN CREEK RD | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275365919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524928576 | ||||||||
| FaxNumber: | 2524927464 | ||||||||
| Practice Location | |||||||||
| Address1: | 511 RUIN CREEK RD | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275365919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524928576 | ||||||||
| FaxNumber: | 2524927464 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 27945 | NC | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 5580075 | 01 | NC | AETNA | OTHER | 07-55208 | 01 | NC | UNITEDHEALTH CARE | OTHER | 55399 | 01 | NC | BLUE CROSS OF NC | OTHER | 151108 | 01 | NC | WELLPATH | OTHER | 27751 | 01 | NC | MEDCOST | OTHER | 89-55399 | 05 | NC | MEDICAID | 072995 | 01 | VA | BLUE CROSS OF VA | OTHER |