MEDICARE: CALVICE CASEY

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
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1003343047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALVICE CASEY

Provider Business Mailing Address
First Line	:	HC 32 BOX 28
Second Line	:
City	:	MT JUDEA
State	:	AR
Zip	:	72655
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	HC 32 BOX 28
Second Line	:
City	:	MOUNT JUDEA
State	:	AR
Zip	:	72655-9406
Country	:	US
Telephone Number	:	870-688-3422
Fax Number	:	870-688-3422

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2017
Last Update Date	:	05/22/2017

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Directions to “ CALVICE CASEY ” Practice Location

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