Provider Demographics
NPI:1982841250
Name:CENTRAL VALLEY COLON & RECTAL SURGICAL ASSOCIATES, INC.
Entity type:Organization
Organization Name:CENTRAL VALLEY COLON & RECTAL SURGICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARVETH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-440-0283
Mailing Address - Street 1:6121 N THESTA ST STE 202
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5294
Mailing Address - Country:US
Mailing Address - Phone:559-440-0283
Mailing Address - Fax:559-440-0192
Practice Address - Street 1:6121 N THESTA ST STE 202
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5294
Practice Address - Country:US
Practice Address - Phone:559-440-0283
Practice Address - Fax:559-440-0192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51200208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty