Provider Demographics
NPI:1104137652
Name:JASON R. CASEY, M.D., P.A.
Entity type:Organization
Organization Name:JASON R. CASEY, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:R
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-931-7383
Mailing Address - Street 1:PO BOX 1800
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-1800
Mailing Address - Country:US
Mailing Address - Phone:870-931-7383
Mailing Address - Fax:870-931-7353
Practice Address - Street 1:901 OSLER DR
Practice Address - Street 2:SUITE B
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4390
Practice Address - Country:US
Practice Address - Phone:870-931-7383
Practice Address - Fax:870-931-7353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2011-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7674207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR121764001Medicaid
AR1164401394OtherNPI (INDIVIDUAL)
AR121764001Medicaid