Carruth, Larry W

Carruth, Larry W is an sole proprietor health care provider with primary practice located at 96 Physicians Dr 96 Physicians Drive, Jackson TN 38305-2070. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Carruth, Larry W can be contacted via phone (731) 664-8771.

Contact Information

Primary practice address
96 Physicians Dr 96 Physicians Drive Jackson TN 38305-2070
Phone: (731) 664-8771
Fax: (731) 660-7050
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X MD009363 Tennessee

Profile Details

NPI number 1306835483
LBN Legal business name Carruth, Larry W
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 20th, 2005
Last updated Apr 6th, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306835483 NPPES
Tennessee Other 621582944 TAX ID -COMMERCIAL INS
Tennessee Other 000050023 TAX ID -COMMERCIAL INS
Tennessee MEDICAID 3170825 TAX ID -COMMERCIAL INS

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