Healthcare Provider Details

I. General information

NPI: 1598462129
Provider Name (Legal Business Name): CASEY D WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4951 S WHITE MOUNTAIN RD
SHOW LOW AZ
85901-7827
US

IV. Provider business mailing address

200 W CRYSTAL CIR
SHOW LOW AZ
85901-4791
US

V. Phone/Fax

Practice location:
  • Phone: 928-240-4128
  • Fax:
Mailing address:
  • Phone: 928-537-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberE82309824
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code246W00000X
TaxonomyCardiology Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: