Provider Demographics
NPI:1407181076
Name:CARROLL CLINIC PA
Entity Type:Organization
Organization Name:CARROLL CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-520-6360
Mailing Address - Street 1:4101 GREENBRIAR ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-5294
Mailing Address - Country:US
Mailing Address - Phone:713-520-6360
Mailing Address - Fax:713-520-6363
Practice Address - Street 1:4101 GREENBRIAR ST
Practice Address - Street 2:SUITE 208
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-5294
Practice Address - Country:US
Practice Address - Phone:713-520-6360
Practice Address - Fax:713-520-6363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-14
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7087207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0A5627Medicare PIN