MEDICARE: MCCARROLL MANAGEMENT CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	05004731	IN
2	313M00000X	Nursing Facility/Intermediate Care Facility	050004731	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000097937	OTHER	IN	ANTHEM BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609871292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCCARROLL MANAGEMENT CORPORATION

Provider Business Mailing Address
First Line	:	1316 N TIBBS AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46222-3024
Country	:	US
Telephone Number	:	317-634-8330
Fax Number	:	317-263-9442

Provider Business Practice Location Address
First Line	:	1316 N TIBBS AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46222-3024
Country	:	US
Telephone Number	:	317-634-8330
Fax Number	:	317-263-9442

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DAVID L MCCARROLL
Credential	:
Telephone Number	:	317-634-8330

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	10/30/2012

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Directions to “MCCARROLL MANAGEMENT CORPORATION ” Practice Location

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