Provider Demographics
NPI:1437481918
Name:LINUS CARROLL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:LINUS CARROLL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ELDREDGE
Authorized Official - Middle Name:LINUS
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:318-953-3443
Mailing Address - Street 1:PO BOX 959
Mailing Address - Street 2:LINUS CARROLL MEDICAL CORPORATION
Mailing Address - City:COLUMBIA
Mailing Address - State:LA
Mailing Address - Zip Code:71418
Mailing Address - Country:US
Mailing Address - Phone:318-495-3131
Mailing Address - Fax:318-495-3229
Practice Address - Street 1:1102 NORTH PINE RD
Practice Address - Street 2:HARDTNER MEDICAL CENTER
Practice Address - City:OLLA
Practice Address - State:LA
Practice Address - Zip Code:71465
Practice Address - Country:US
Practice Address - Phone:318-495-3131
Practice Address - Fax:318-495-3229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1110388Medicaid
LA1110388Medicaid