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Provider Connect Home

Provider Demographics

Provider
PETER TUMNUS
Mailing Address:


Edit
ID: 123456
Address: 123 Main st
STE C
ABC, VA 12345
Country: US
Phone: 888 - 888 - 8888
Fax: 888 - 888 - 8888
Website address:
ProviderConnect Email:
TESTEMAIL@CARELON.com
Correspondence Email:
TESTEMAIL@GMAIL.COM

 
Identify any foreign language(s) or sign language that you use fluently in treating patients
This is required information for network participation. When you press submit, you attest your responses are accurate. Carelon Behavioral Health may request documentation to verify the information.
Medical Provider Type
AMER OSTEO BD OF GENERAL PRACTICE
Specialty Populations
Physically & Developmentally Disabled Y
Children & Foster Children Y
Adults & the Aged N
Non-English Speaking N
Members with Complex Behavioral or Physical Health Needs Y
Members with HIV N
Frail Elderly Y
Members who are released from DOC/Jail Y
Provider Completed Training for Cultural Competency
Y
 

Service Location Information

The list below shows the current Service Locations for the Provider shown above.
If you would like to view the Service Address' corresponding Billing Location, click the green "Show" tab to expand the selection.

Sort By: ID  Name  City  State
                                 Service Address
 
Corresponding Billing Address
 
1
 ID: A00003
Provider Type: CLINIC
Edit Remove
Name:
PETER TUMNUS
PETER TUMNUS
Address: 123 Main Street
STE C
ABC,  VA 12345
Country: US
Phone:
 *
(888) 888 - 8888
()  -  Ext:
 
Fax:
(777) 777 - 7777
()  -  Ext:
Office Hours:
Accepting New patients  
Email, Website,
Disability Access
Primary Practice
Public Transportation Access
Medicaid Panel Size Limit, Medicaid Provider Location ID
Provider ADA Compliant   
Monday Tuesday
From 8:30am 8:30am
To 5:30pm 5:30pm
Wednesday Thursday
From 8:30am 8:30am
To 5:30pm 5:30pm
Friday Saturday
From 8:30am
To 5:30pm
Sunday
From
To
Monday Tuesday
From
To
Wednesday Thursday
From
To
Friday Saturday
From
To
Sunday
From
To
Accepting New Patients: Yes
Email Address:
Website:
Disability Access: Yes No
Please enter effective date of address removal
cal ( mm/dd/yyyy)  *
 * Required Field


 
1
ID: A00003 * Same as Service Address  
Edit Replace
 
Name: PETER TUMNUS  
Address: 123 Main Street
STE C
ABC,  VA 12345
Country: US  
Fed Tax Id:
 11111111    Tax Id Type: EIN  
Phone:
 *
(888) 888 - 8888
()  -  Ext:
 
Fax:
(888) 888 - 8888
()  -  Ext:
 
 * Required Field
 
2
 ID: A000004
Provider Type:
Edit Remove
Name:
PETER TUMNUS
PETER TUMNUS
PETER TUMNUS
Address: 123 Main Street
STE C
ABC,  VA 12345
Country: US
Phone:
 *
(888) 888 - 8888
()  -  Ext:
 
Fax:
(777) 777 - 7777
()  -  Ext:
Office Hours:
Accepting New patients  
Email, Website,
Disability Access
Primary Practice
Public Transportation Access
Medicaid Panel Size Limit, Medicaid Provider Location ID
Provider ADA Compliant   
Monday Tuesday
From 8:30am 8:30am
To 5:30pm 5:30pm
Wednesday Thursday
From 8:30am 8:30am
To 5:30pm 5:30pm
Friday Saturday
From 8:30am
To 5:30pm
Sunday
From
To
Monday Tuesday
From
To
Wednesday Thursday
From
To
Friday Saturday
From
To
Sunday
From
To
Accepting New Patients: Yes
Email Address:
Website:
Primary Practice: * Yes No
Disability Access: * Yes No
Public Transportation Access: * Yes No
Please enter effective date of address removal
cal ( mm/dd/yyyy)  *
 * Required Field


 
2
ID: A000004  
Edit Replace
 
Name: PETER TUMNUS  
Address: 123 Main Street
STE C
ABC,  VA 12345
Country: US  
Fed Tax Id:
 11111111    Tax Id Type: EIN  
Phone:
 *
(888) 888 - 8888
()  -  Ext:
 
Fax:
(888) 888 - 8888
()  -  Ext:
 
 * Required Field