MEDICARE: BRIAN ERVIN CARTER

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1790292738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN ERVIN CARTER

Provider Business Mailing Address
First Line	:	300 N CLEVELAND MASSILLON RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44333-2484
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 N CLEVELAND MASSILLON RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44333-2484
Country	:	US
Telephone Number	:	330-396-0634
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2017
Last Update Date	:	12/29/2017

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