1902801251 NPI number — DR. SEAN P CASEY DC

Table of content: DR. SEAN P CASEY DC (NPI 1902801251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902801251 NPI number — DR. SEAN P CASEY DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASEY
Provider First Name:
SEAN
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
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:
1902801251
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5445 TELEGRAPH RD STE 115
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63129-3500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-416-4900
Provider Business Mailing Address Fax Number:
314-487-4669

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5445 TELEGRAPH RD STE 115
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63129-3500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-416-4900
Provider Business Practice Location Address Fax Number:
314-487-4669
Provider Enumeration Date:
06/14/2005

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: 111N00000X , with the licence number:  006147 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 230100037 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: U48285 . This is a "MERCY HEALTH PLANS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 4422000 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 230985 . This is a "GREAT WEST" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 350032867 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 5062 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 58803 . This is a "CMR" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 107978 . This is a "GHP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 230985 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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