Provider Demographics
NPI:1205077658
Name:CARVER FAMILY HEALTH & WELLNESS PA
Entity type:Organization
Organization Name:CARVER FAMILY HEALTH & WELLNESS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARVER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:785-234-8601
Mailing Address - Street 1:1125 SW GAGE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-2281
Mailing Address - Country:US
Mailing Address - Phone:785-234-8601
Mailing Address - Fax:785-234-2575
Practice Address - Street 1:1125 SW GAGE BLVD STE A
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-2281
Practice Address - Country:US
Practice Address - Phone:785-234-8601
Practice Address - Fax:785-234-2575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-25857305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSG65536Medicare UPIN