# MOUNTCASTLE MEDICAL & MED SPA PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518532126
- **Authorized official:** BRANDY N MOUNTCASTLE PA-C (MEMBER, ORGANIZER, OWNER, CEO, PA-C)
- **Authorized official phone:** (910) 890-6590

## Contact information

- **Practice address:** 701 S MAIN ST, LILLINGTON, NC 27546-7681
- **Practice address phone:** (910) 984-1152
- **Practice address fax:** (910) 984-1171
- **Mailing address:** 701 S MAIN ST, LILLINGTON, NC 27546-7681
- **Mailing address phone:** (910) 984-1152
- **Mailing address fax:** (910) 984-1171

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204C00000X | Sports Medicine (Neuromusculoskeletal Medicine) Physician | — | NULL | — |
| 204C00000X | Sports Medicine (Neuromusculoskeletal Medicine) Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207QA0401X | Addiction Medicine (Family Medicine) Physician | — | NULL | — |
| 207QA0401X | Addiction Medicine (Family Medicine) Physician | — | — | — |
| 207QS1201X | Sleep Medicine (Family Medicine) Physician | — | NULL | — |
| 207QS1201X | Sleep Medicine (Family Medicine) Physician | — | — | — |
| 208VP0014X | Interventional Pain Medicine Physician | — | NULL | — |
| 208VP0014X | Interventional Pain Medicine Physician | — | — | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |

## Other

- **Enumeration date:** 05/25/2021
- **Last updated:** 07/12/2021