Provider Demographics
NPI:1982976700
Name:CASA SAN PIO CLINICS OF APPALACHIA, LLC
Entity Type:Organization
Organization Name:CASA SAN PIO CLINICS OF APPALACHIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:TAUFIK
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-318-3500
Mailing Address - Street 1:638 E COLLEGE AVE
Mailing Address - Street 2:STE B
Mailing Address - City:STANTON
Mailing Address - State:KY
Mailing Address - Zip Code:40380-2363
Mailing Address - Country:US
Mailing Address - Phone:606-318-3500
Mailing Address - Fax:606-318-3503
Practice Address - Street 1:638 E COLLEGE AVE
Practice Address - Street 2:STE B
Practice Address - City:STANTON
Practice Address - State:KY
Practice Address - Zip Code:40380-2363
Practice Address - Country:US
Practice Address - Phone:606-318-3500
Practice Address - Fax:606-318-3503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100221330Medicaid