Provider Demographics
NPI:1235221169
Name:CARROLL FAMILY HEALTHCARE
Entity Type:Organization
Organization Name:CARROLL FAMILY HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-863-9061
Mailing Address - Street 1:635 LOCUST STREET
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:OH
Mailing Address - Zip Code:44644
Mailing Address - Country:US
Mailing Address - Phone:330-863-9061
Mailing Address - Fax:330-863-6492
Practice Address - Street 1:635 LOCUST ST
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:OH
Practice Address - Zip Code:44644
Practice Address - Country:US
Practice Address - Phone:330-863-9061
Practice Address - Fax:330-863-6492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCA9315561Medicare ID - Type UnspecifiedMCR GROUP NUMBER