Provider Demographics
NPI:1881622587
Name:KIRK CASEY, M.D., A MEDICAL CORPORATION
Entity type:Organization
Organization Name:KIRK CASEY, M.D., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-879-0400
Mailing Address - Street 1:2565 CEANOTHUS AVE SUITE 150
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-7615
Mailing Address - Country:US
Mailing Address - Phone:530-879-0400
Mailing Address - Fax:530-879-0404
Practice Address - Street 1:2565 CEANOTHUS AVE SUITE 150
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-7615
Practice Address - Country:US
Practice Address - Phone:530-879-0400
Practice Address - Fax:530-879-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61633208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1972568467OtherINDIVIDUAL NPI