Basic Information
Provider Information | |||||||||
NPI: | 1316965478 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CASEY | ||||||||
FirstName: | JOSEPH | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | P.O. BOX 706 | ||||||||
Address2: |   | ||||||||
City: | PLYMOUTH | ||||||||
State: | NH | ||||||||
PostalCode: | 032640706 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6034818757 | ||||||||
FaxNumber: | 6032382163 | ||||||||
Practice Location | |||||||||
Address1: | 16 HOSPITAL ROAD | ||||||||
Address2: | SPEARE SURGICAL SERVICES | ||||||||
City: | PLYMOUTH | ||||||||
State: | NH | ||||||||
PostalCode: | 03264 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6035365670 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/17/2006 | ||||||||
LastUpdateDate: | 10/20/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 9314 | NH | Y |   | Other Service Providers | Specialist |   | 208600000X | 9314 | NH | N |   | Allopathic & Osteopathic Physicians | Surgery |   |
ID Information
ID | Type | State | Issuer | Description | 020025324 | 01 | NH | RAILROAD MEDICARE | OTHER | 30007490 | 05 | NH |   | MEDICAID | 0RE3402 | 05 | VT |   | MEDICAID | 0104398Y0NH02 | 01 | NH | ANTHEM | OTHER | 3073200 | 05 | NH |   | MEDICAID | F54875 | 01 |   | HARVARD PILGRIM | OTHER | 100779800 | 01 |   | US DEPT OF LABOR | OTHER | 213870 | 01 |   | CIGNA | OTHER | ORE3402 | 05 | VT |   | MEDICAID |