Provider Demographics
NPI:1770995979
Name:HORN, CASEY
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:HORN
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 1:3116 S MILL AVE STE 162
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-3674
Mailing Address - Country:US
Mailing Address - Phone:602-717-7985
Mailing Address - Fax:
Practice Address - Street 1:13784 W VENTURA ST
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-8413
Practice Address - Country:US
Practice Address - Phone:602-717-7985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)