Provider Demographics
NPI:1457553943
Name:DAVID L CASE MD LLC
Entity Type:Organization
Organization Name:DAVID L CASE MD LLC
Other - Org Name:DIPLOMATE ONCOLOGY HEMATOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:CASE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-753-2050
Mailing Address - Street 1:PO BOX 3565
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38557-3565
Mailing Address - Country:US
Mailing Address - Phone:931-787-1500
Mailing Address - Fax:931-787-1503
Practice Address - Street 1:300 S 8TH ST
Practice Address - Street 2:SUITE 376 W
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2400
Practice Address - Country:US
Practice Address - Phone:270-753-2050
Practice Address - Fax:270-767-3635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY27433261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1583OtherRR MEDICARE PIN
KY64093735Medicaid
KYD45028Medicare UPIN
KY64093735Medicaid