Basic Information
| Provider Information | |||||||||
| NPI: | 1407855471 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARTER | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | S | ||||||||
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| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1308 | ||||||||
| Address2: | |||||||||
| City: | KINGSPORT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376621308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232243460 | ||||||||
| FaxNumber: | 4232243465 | ||||||||
| Practice Location | |||||||||
| Address1: | 135 W RAVINE RD | ||||||||
| Address2: | SUITE 5-B | ||||||||
| City: | KINGSPORT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376603847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232243460 | ||||||||
| FaxNumber: | 4232243465 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2005 | ||||||||
| LastUpdateDate: | 09/11/2013 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 10/05/2012 | ||||||||
| NPIReactivationDate: | 09/11/2013 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 6641 | TN | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 030255 | 01 | ANTHEM BCBS | OTHER | 100010846 | 05 | TN | MEDICAID | 64916059 | 01 | KY | KY MEDICAID | OTHER | 8905287 | 05 | NC | MEDICAID | 00013859 | 01 | NHC CARE ADMIN. | OTHER | 3046935 | 01 | BS OF TN | OTHER | 3810000411 | 05 | WV | MEDICAID | 3158320 | 05 | TN | MEDICAID | TN0100 | 01 | JOHN DEERE | OTHER | 005745829 | 05 | VA | MEDICAID |