MEDICARE: MARIO CARVER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)	153	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4170614	OTHER	TN	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730262320
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIO CARVER

Provider Business Mailing Address
First Line	:	P. O. BOX 162398
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38186
Country	:	US
Telephone Number	:	901-396-6221
Fax Number	:	901-396-6224

Provider Business Practice Location Address
First Line	:	1128 WINCHESTER RD STE 103
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38116-3151
Country	:	US
Telephone Number	:	901-396-6221
Fax Number	:	901-509-8374

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MARIO ANDRE CARVER
Credential	:	CFTS
Telephone Number	:	901-486-9338

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	04/21/2023

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Directions to “MARIO CARVER ” Practice Location

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