Provider Demographics
NPI:1003343047
Name:CASEY, CALVICE
Entity Type:Individual
Prefix:
First Name:CALVICE
Middle Name:
Last Name:CASEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 32 BOX 28
Mailing Address - Street 2:
Mailing Address - City:MT JUDEA
Mailing Address - State:AR
Mailing Address - Zip Code:72655
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HC 32 BOX 28
Practice Address - Street 2:
Practice Address - City:MOUNT JUDEA
Practice Address - State:AR
Practice Address - Zip Code:72655-9406
Practice Address - Country:US
Practice Address - Phone:870-688-3422
Practice Address - Fax:870-688-3422
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator