Basic Information
| Provider Information | |||||||||
| NPI: | 1467564690 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARROLL FAMILY PHYSICIANS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4127 | ||||||||
| Address2: | CARROLL FAMILY PHYSICIANS INC | ||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5409810283 | ||||||||
| FaxNumber: | 5403447154 | ||||||||
| Practice Location | |||||||||
| Address1: | 523 NORTH MAIN STREET | ||||||||
| Address2: | CARROLL FAMILY PHYSICIANS INC | ||||||||
| City: | HILLSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2767684311 | ||||||||
| FaxNumber: | 2767280901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2006 | ||||||||
| LastUpdateDate: | 07/13/2007 | ||||||||
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| AuthorizedOfficialLastName: | DEBOE | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | HENRY | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2767284311 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 226463 | 01 | ANTHEM | OTHER | B09393 | 01 | UPIN | OTHER |