1164425088 NPI number — CASEY B MCGHEE P.T.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164425088 NPI number — CASEY B MCGHEE P.T.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

MCGHEE

Provider First Name:

CASEY

Provider Middle Name:

B

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

P.T.

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

MALONE

Provider Other First Name:

CASEY

Provider Other Middle Name:

B

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

PT

Provider Other Last Name Type Code:

1

NPI Number:

1164425088

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

05/08/2020

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

6077 PRIMACY PKWY STE 140

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

MEMPHIS

Provider Business Mailing Address State Name:

TN

Provider Business Mailing Address Postal Code:

38119-5742

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

901-725-8347

Provider Business Mailing Address Fax Number:

901-259-7637

Provider First Line Business Practice Location Address:

7580 CLARINGTON CV

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SOUTHAVEN

Provider Business Practice Location Address State Name:

MS

Provider Business Practice Location Address Postal Code:

38671-5657

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

901-641-3000

Provider Business Practice Location Address Fax Number:

901-259-1698

Provider Enumeration Date:

05/24/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 225100000X , with the licence number:  6882 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 110318002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
• Identifier: 4067711 . This is a "BLUE CROSS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
• Identifier: 620819926 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
• Identifier: 7122465 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
• Identifier: 7187860 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
• Identifier: 172494795 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
• Identifier: 3371161 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
• Identifier: 620819926 . This is a "TRICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
• Identifier: 3645208 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
• Identifier: 620819926 . This is a "BCBS" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
• Identifier: 620819926 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
• Identifier: 06027562 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".