Healthcare Provider Details

I. General information

NPI: 1235221169
Provider Name (Legal Business Name): CARROLL FAMILY HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 LOCUST ST
MALVERN OH
44644
US

IV. Provider business mailing address

635 LOCUST STREET
MALVERN OH
44644
US

V. Phone/Fax

Practice location:
  • Phone: 330-863-9061
  • Fax: 330-863-6492
Mailing address:
  • Phone: 330-863-9061
  • Fax: 330-863-6492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TANYA L SMITH
Title or Position: OFFICE MANAGER
Credential:
Phone: 330-863-9061