Healthcare Provider Details

I. General information

NPI: 1518268747
Provider Name (Legal Business Name): KARIS MCCARROLL MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2010
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16110 VIA SHAVANO
SAN ANTONIO TX
78249-2380
US

IV. Provider business mailing address

16110 VIA SHAVANO
SAN ANTONIO TX
78249-2380
US

V. Phone/Fax

Practice location:
  • Phone: 210-615-7171
  • Fax: 210-615-6793
Mailing address:
  • Phone: 210-615-7171
  • Fax: 210-615-6793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG5032
License Number StateTX

VIII. Authorized Official

Name: MS. SARA R PACHECO
Title or Position: BILLING/CREDENTIALLING
Credential:
Phone: 210-615-1406