Healthcare Provider Details

I. General information

NPI: 1184436974
Provider Name (Legal Business Name): CASEY ANESTHESIA SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2025
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3689 N STEELE BLVD
FAYETTEVILLE AR
72703-5347
US

IV. Provider business mailing address

PO BOX 570
LAKE FOREST IL
60045-0570
US

V. Phone/Fax

Practice location:
  • Phone: 479-249-6006
  • Fax: 479-287-4294
Mailing address:
  • Phone: 888-987-1489
  • Fax: 224-255-5813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: JOSH CASEY
Title or Position: PRESIDENT
Credential: CRNA
Phone: 501-887-6329