MEDICARE: CASY WILLAIM BYRD NRP, CCP

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	146L00000X	Paramedic	060083516	IL
2	146L00000X	Paramedic	PM-99-509-85	IA

General Provider Information

NPI Number	:	1851780506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASY WILLAIM BYRD NRP, CCP

Provider Business Mailing Address
First Line	:	3415 N ROCHELLE LN
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61604-1076
Country	:	US
Telephone Number	:	309-494-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	3415 N ROCHELLE LN
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61604-1076
Country	:	US
Telephone Number	:	309-494-6200
Fax Number	:

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

Provider Enumeration Date	:	01/20/2015
Last Update Date	:	03/13/2015

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