Provider Demographics
NPI:1093091209
Name:CARROLL FAMILY PRACTICE
Entity Type:Organization
Organization Name:CARROLL FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-745-6100
Mailing Address - Street 1:PO BOX 808
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:AR
Mailing Address - Zip Code:72031-0808
Mailing Address - Country:US
Mailing Address - Phone:501-745-6100
Mailing Address - Fax:501-745-6128
Practice Address - Street 1:244 HIGHWAY 65 N
Practice Address - Street 2:SUITE 1
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031-6390
Practice Address - Country:US
Practice Address - Phone:501-745-6100
Practice Address - Fax:501-745-6128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC8231207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR124580001Medicaid
AR5J262OtherBLUECROSS ARKANSAS
AR5J262B477OtherMEDICARE PIN
ARP00014280OtherRAILROAD PIN
ARP00014280Medicare PIN
AR5J262B477OtherMEDICARE PIN
AR124580001Medicaid