Provider Demographics
NPI:1265617005
Name:CARROLL FAMILY PRACTICE INC
Entity type:Organization
Organization Name:CARROLL FAMILY PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEROY
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:VARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-653-7121
Mailing Address - Street 1:2318 E MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-9351
Mailing Address - Country:US
Mailing Address - Phone:740-653-7121
Mailing Address - Fax:740-653-7122
Practice Address - Street 1:2318 E MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-9351
Practice Address - Country:US
Practice Address - Phone:740-653-7121
Practice Address - Fax:740-653-7122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207Q00000X207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2430462Medicaid