Individual ProviderGary Q CaseyFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address444 Clinchfield Street, Suite 201, Kingsport, TN 37660-3606(423) 230-2100PECOS EnrollmentBased on the most recent information from CMS, provider Gary Q Casey does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 4:18 PM.Profile DetailsProvider ID1770534539Provider TypeIndividualFull NameCasey, Gary QCredentialMDGenderMaleSole ProprietorNoEnumeration Date5/15/2006Last Updated1/3/2012Contact InformationPractice LocationPractice Address444 Clinchfield Street, Suite 201, Kingsport, TN 37660-3606Phone(423) 230-2100Fax(423) 230-2112Mailing LocationMailing Address444 Clinchfield Street, Suite 201, Kingsport, TN 37660-3606Phone(423) 230-2100Fax(423) 230-2112Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseMD11383TennesseeProvider IdentifiersIDDescriptionIssuerID62158439104DescriptionOtherIssuerJOHN DEERETennesseeID3009244DescriptionMedicaidIssuerUnlistedTennesseeIDCA4007DescriptionOtherIssuerMEDICARE RAILROADTennesseeID2009646DescriptionOtherIssuerBLUE CROSS BLUE SHIELDTennesseeID5609844DescriptionOtherIssuerMEDICAIDVirginiaID1337280DescriptionOtherIssuerBLACK LUNGTennesseeID209176DescriptionOtherIssuerUMWATennesseeID37060DescriptionOtherIssuerBLUE CROSS BLUE SHIELDVirginia