Provider Demographics
NPI:1548618556
Name:CASEY, RODERICK (EMT)
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:
Last Name:CASEY
Suffix:
Gender:M
Credentials:EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2924 KNIGHT ST
Mailing Address - Street 2:SUITE 426
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-2415
Mailing Address - Country:US
Mailing Address - Phone:318-754-3560
Mailing Address - Fax:318-779-0439
Practice Address - Street 1:2924 KNIGHT ST
Practice Address - Street 2:SUITE 426
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2415
Practice Address - Country:US
Practice Address - Phone:318-754-3560
Practice Address - Fax:318-779-0439
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA146L00000X146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic