Basic Information
| Provider Information | |||||||||
| NPI: | 1861428898 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCARVER | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 426 WHITE AVE | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383401914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7319892174 | ||||||||
| FaxNumber: | 7319893891 | ||||||||
| Practice Location | |||||||||
| Address1: | 426 WHITE AVE | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383401914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7319892174 | ||||||||
| FaxNumber: | 7319893891 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2006 | ||||||||
| LastUpdateDate: | 07/14/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 37020 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 144224 | 05 | TN | MEDICAID | 27403 | 05 | TN | MEDICAID | 4063262 | 01 | TN | BLUE CROSS BLUE SHIELD H | OTHER | 4063255 | 01 | TN | BLUE CROSS BLUE SHIELD S | OTHER | 4063265 | 01 | TN | BLUE CROSS BLUE SHIELD A | OTHER | 3717101 | 05 | TN | MEDICAID |