Basic Information
| Provider Information | |||||||||
| NPI: | 1407181076 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARROLL CLINIC PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4101 GREENBRIAR ST | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770985294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135206360 | ||||||||
| FaxNumber: | 7135206363 | ||||||||
| Practice Location | |||||||||
| Address1: | 4101 GREENBRIAR ST | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770985294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135206360 | ||||||||
| FaxNumber: | 7135206363 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2009 | ||||||||
| LastUpdateDate: | 03/11/2010 | ||||||||
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| AuthorizedOfficialLastName: | CARROLL | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | MD/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7135206360 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | M7087 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.