Provider Demographics
NPI:1518268747
Name:KARIS MCCARROLL MD PA
Entity Type:Organization
Organization Name:KARIS MCCARROLL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/CREDENTIALLING
Authorized Official - Prefix:MS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PACHECO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-615-1406
Mailing Address - Street 1:16110 VIA SHAVANO
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2380
Mailing Address - Country:US
Mailing Address - Phone:210-615-7171
Mailing Address - Fax:210-615-6793
Practice Address - Street 1:16110 VIA SHAVANO
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2380
Practice Address - Country:US
Practice Address - Phone:210-615-7171
Practice Address - Fax:210-615-6793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5032174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097574002Medicaid
TXC19033Medicare UPIN
TX097574002Medicaid
TX00B79CMedicare PIN