Provider Demographics
NPI:1245816719
Name:CARVER, MARIO
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:CARVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 162398
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38186-2398
Mailing Address - Country:US
Mailing Address - Phone:901-486-9338
Mailing Address - Fax:901-502-8374
Practice Address - Street 1:3333 ELVIS PRESLEY BLVD STE 203
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-3288
Practice Address - Country:US
Practice Address - Phone:901-486-9338
Practice Address - Fax:901-509-8374
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS008573390332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment