Provider Demographics
NPI:1730262320
Name:MARIO CARVER
Entity type:Organization
Organization Name:MARIO CARVER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:ANDRE
Authorized Official - Last Name:CARVER
Authorized Official - Suffix:
Authorized Official - Credentials:CFTS
Authorized Official - Phone:901-486-9338
Mailing Address - Street 1:P. O. BOX 162398
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38186
Mailing Address - Country:US
Mailing Address - Phone:901-396-6221
Mailing Address - Fax:901-396-6224
Practice Address - Street 1:1128 WINCHESTER RD STE 103
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-3151
Practice Address - Country:US
Practice Address - Phone:901-396-6221
Practice Address - Fax:901-509-8374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN153332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4170614OtherBCBS
MS08573390Medicaid
TN1455187Medicaid