Provider Demographics
NPI:1528130051
Name:MCCARROLL PRIMARY CARE
Entity type:Organization
Organization Name:MCCARROLL PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCCARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-798-6560
Mailing Address - Street 1:P.O. BOX 687
Mailing Address - Street 2:
Mailing Address - City:ALMONT
Mailing Address - State:MI
Mailing Address - Zip Code:48003
Mailing Address - Country:US
Mailing Address - Phone:810-798-6560
Mailing Address - Fax:
Practice Address - Street 1:198 N. MAIN ST
Practice Address - Street 2:
Practice Address - City:ALMONT
Practice Address - State:MI
Practice Address - Zip Code:48003
Practice Address - Country:US
Practice Address - Phone:810-798-6560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBM007710207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104279OtherCARE CHOICES
MI124180OtherGREAT LAKES HEALTH PLAN
MI0154410164OtherBCBS
MIC8031OtherM-CARE
MI4679001Medicaid
MIB47661Medicare UPIN
MI4679001Medicaid