Basic Information
| Provider Information | |||||||||
| NPI: | 1447480660 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CASADY FAMILY MEDICINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3821 71ST ST STE B | ||||||||
| Address2: | |||||||||
| City: | URBANDALE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503223259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152267888 | ||||||||
| FaxNumber: | 5152373979 | ||||||||
| Practice Location | |||||||||
| Address1: | 3821 71ST ST STE B | ||||||||
| Address2: | |||||||||
| City: | URBANDALE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503223259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152267888 | ||||||||
| FaxNumber: | 5152373979 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2009 | ||||||||
| LastUpdateDate: | 05/05/2022 | ||||||||
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| AuthorizedOfficialLastName: | CASADY | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | MARGARET | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE MBR | ||||||||
| AuthorizedOfficialTelephone: | 5152267888 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D O | ||||||||
| NPICertificationDate: | 05/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 03230 | IA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1447480660 | 05 | IA | MEDICAID | 1447480660 | 01 | IA | BCBS OF IOWA | OTHER |