Organization
CRISTO REY HEALTHCARE, LLC
Active
Other names
Jesuit Lane Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARL BRUCE CARROLL M.D. (PHYSICIAN)
(785) 437-3711
Entity
Organization
Contact information
Practice address
907A E JESUIT LN, ST MARYS, KS 66536-9605
(785) 437-3711
(785) 437-6711
Mailing address
907A E JESUIT LN, ST MARYS, KS 66536-9605
(785) 437-3711
(785) 437-6711
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
04-23089
KS
Other
Enumeration date
02/28/2006
Last updated
08/22/2020
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