MEDICARE: JEROME P. CASEY DPM PC

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	213ES0103X	Foot & Ankle Surgery Podiatrist	SC002702L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17369	OTHER	PA	GEISINGER
2	817221	OTHER	PA	FIRST PRIORITY HEALTH
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	3184931	OTHER	PA	AETNA

General Provider Information

NPI Number	:	1336478338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEROME P. CASEY DPM PC

Provider Business Mailing Address
First Line	:	401 CHURCH ST
Second Line	:
City	:	ARCHBALD
State	:	PA
Zip	:	18403-2101
Country	:	US
Telephone Number	:	570-876-1440
Fax Number	:	570-876-0556

Provider Business Practice Location Address
First Line	:	401 CHURCH ST
Second Line	:
City	:	ARCHBALD
State	:	PA
Zip	:	18403-2101
Country	:	US
Telephone Number	:	570-876-1440
Fax Number	:	570-876-0556

Authorized Official
Title or Position	:	PODIATRIST
Name	:	DR. JEROME P CASEY
Credential	:	DPM
Telephone Number	:	570-876-1440

Provider Enumeration Date	:	12/22/2009
Last Update Date	:	12/22/2009

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