1073610754 NPI number — DR. TERENCE THOMAS CASEY M.D.

Table of content: MS. MY-HANG THI PHAM PA-C (NPI 1538419635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073610754 NPI number — DR. TERENCE THOMAS CASEY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASEY
Provider First Name:
TERENCE
Provider Middle Name:
THOMAS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073610754
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3780
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUPELO
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38803-3780
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-841-9526
Provider Business Mailing Address Fax Number:
318-841-9551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 FOUCHER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-897-8418
Provider Business Practice Location Address Fax Number:
504-897-8762
Provider Enumeration Date:
09/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  17902 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X , with the licence number: 33861 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X , with the licence number: 016061 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5902737 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009963710 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10057953 . This is a "AMERIGROUP MEDICAID GA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 3040731 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 335761 . This is a "WELLCARE MEDICAID GA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 644219559A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3090762 . This is a "BLUE CROSS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1901211 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000009032 . This is a "TLC TENNCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 100031448 . This is a "PHP TENNCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 119402 . This is a "UNISON TENNCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 64720642 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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