Provider Demographics
NPI:1649353202
Name:CASE FAMILY PRACTICE AND SPORTS MEDICINE, LLC
Entity type:Organization
Organization Name:CASE FAMILY PRACTICE AND SPORTS MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CASE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-449-1710
Mailing Address - Street 1:272 CARTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-5851
Mailing Address - Country:US
Mailing Address - Phone:302-449-1713
Mailing Address - Fax:302-449-1717
Practice Address - Street 1:272 CARTER DR STE 200
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-5851
Practice Address - Country:US
Practice Address - Phone:302-449-1713
Practice Address - Fax:302-449-1717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1520203OtherAMERIHEALTH PPO
DEKEI5CAOtherCAREFIRST BCBS MD
DE2207011000OtherAMERIAHEALTH HMO
DE=========OtherTRICARE
DE=========OtherALLIANCE, MAMSI, OPT CHOI
DE=========OtherUNITED HEALTH CARE
DE2207011000OtherAMERIAHEALTH HMO
DE1520203OtherAMERIHEALTH PPO
DE=========OtherAETNA
DEKEI5CAOtherCAREFIRST BCBS MD
DE=========OtherBCBS DE
DE=========OtherCOVENTRY