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NPI Code Detail

MEDICARE: MR. TAVANTE CALHOUN MHPP

MEDICARE: MR. TAVANTE CALHOUN MHPP
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1902935786
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TAVANTE CALHOUN MHPP
Provider Business Mailing Address
First Line : 1101 W 3RD ST
Second Line :
City : FORDYCE
State : AR
Zip : 71742-3014
Country : US
Telephone Number : 870-352-5122
Fax Number : 870-352-5127
Provider Business Practice Location Address
First Line : 1101 W 3RD ST
Second Line :
City : FORDYCE
State : AR
Zip : 71742-3014
Country : US
Telephone Number : 870-352-5122
Fax Number : 870-352-5127
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2007
Last Update Date : 07/08/2007

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Directions to “ MR. TAVANTE CALHOUN MHPP” Practice Location

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