1366534745 NPI number — MARK R CARROLL M.S., CCC-A

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366534745 NPI number — MARK R CARROLL M.S., CCC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARROLL
Provider First Name:
MARK
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., CCC-A
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366534745
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 18066
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35804-8066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-536-9300
Provider Business Mailing Address Fax Number:
256-535-9032

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
927 FRANKLIN ST SE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35801-4306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-536-9300
Provider Business Practice Location Address Fax Number:
256-535-9032
Provider Enumeration Date:
09/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  5798 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 640003550 . This is a "RAILROAD RETIREMENT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 51079118 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009801230 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com