Healthcare Provider Details

I. General information

NPI: 1700664521
Provider Name (Legal Business Name): CASEY MAPLES CSFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NORTHCREST DR
SPRINGFIELD TN
37172-3927
US

IV. Provider business mailing address

100 NORTHCREST DR
SPRINGFIELD TN
37172-3927
US

V. Phone/Fax

Practice location:
  • Phone: 256-469-4138
  • Fax:
Mailing address:
  • Phone: 256-469-4138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number176769
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: