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NPI Code Detail

MEDICARE: CASA SAN PIO CLINICS OF APPALACHIA, LLC

MEDICARE: CASA SAN PIO CLINICS OF APPALACHIA, LLC
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
1261QR1300XRural Health Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1982976700
Entity Type Code : Organization
Provider Name (Legal Business Name) : CASA SAN PIO CLINICS OF APPALACHIA, LLC
Provider Business Mailing Address
First Line : 638 E COLLEGE AVE
Second Line : STE B
City : STANTON
State : KY
Zip : 40380-2363
Country : US
Telephone Number : 606-318-3500
Fax Number : 606-318-3503
Provider Business Practice Location Address
First Line : 638 E COLLEGE AVE
Second Line : STE B
City : STANTON
State : KY
Zip : 40380-2363
Country : US
Telephone Number : 606-318-3500
Fax Number : 606-318-3503
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : DR. TAUFIK KASSIS
Credential : MD
Telephone Number : 606-318-3500
Provider Enumeration Date : 02/09/2012
Last Update Date : 07/21/2022

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