Healthcare Provider Details

I. General information

NPI: 1871929877
Provider Name (Legal Business Name): CASIMIR EMERGENCY PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 LEE HWY N
PULASKI VA
24301-2326
US

IV. Provider business mailing address

PO BOX 37964
PHILADELPHIA PA
19101
US

V. Phone/Fax

Practice location:
  • Phone: 540-994-8100
  • Fax:
Mailing address:
  • Phone: 727-533-8703
  • Fax: 727-536-2896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROSS RONAN
Title or Position: VP OF ANCILLARY SERVICES
Credential:
Phone: 800-507-8874