MEDICARE: COLLEEN M CASEY MT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MT0013160	CO

General Provider Information

NPI Number	:	1801222179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN M CASEY MT

Provider Business Mailing Address
First Line	:	2546 W 23RD AVE
Second Line	:	UNIT C
City	:	DENVER
State	:	CO
Zip	:	80211-4822
Country	:	US
Telephone Number	:	206-719-1366
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 LINCOLN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-2710
Country	:	US
Telephone Number	:	206-719-1366
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2013
Last Update Date	:	09/18/2013

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