Provider Demographics
NPI:1538148861
Name:CASAMO, ANTHONY R (PAC)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:R
Last Name:CASAMO
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 N. JAMES CAMPBELL BLVD.
Mailing Address - Street 2:SUITE 105
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401
Mailing Address - Country:US
Mailing Address - Phone:931-388-5114
Mailing Address - Fax:931-388-5631
Practice Address - Street 1:927 N. JAMES CAMPBELL BLVD.
Practice Address - Street 2:SUITE 105
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401
Practice Address - Country:US
Practice Address - Phone:931-388-5114
Practice Address - Fax:931-388-5631
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000000965363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN680539870OtherTAX ID
TN4107597OtherBCBS OF TENNESSEE
3661827Medicare ID - Type Unspecified
TN680539870OtherTAX ID