Active NPI
Virgil Wayne Carroll, ATC/R
- Athletic Trainer
- Anoka, MN
National Provider Identifier
1235534348
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 1334
- Practice address
- 3939 7TH Ave
Anoka, MN 55303-1261 - Phone
- (763) 506-6445
- NPI assigned
- Oct 31, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 1334 | MN | Primary |
Addresses
Primary practice location
3939 7TH Ave
Anoka, MN 55303-1261
Mailing address
2120 County Road C W
Roseville, MN 55113-2501
Phone (763) 201-6040
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1334 | MN | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1414713600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1414713600000",
"number": "1235534348",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2120 COUNTY ROAD C W",
"city": "ROSEVILLE",
"state": "MN",
"postal_code": "551132501",
"telephone_number": "763-201-6040"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3939 7TH AVE",
"city": "ANOKA",
"state": "MN",
"postal_code": "553031261",
"telephone_number": "763-506-6445"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARROLL",
"first_name": "VIRGIL",
"middle_name": "WAYNE",
"name_prefix": "Mr.",
"credential": "ATC/R",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-10-31",
"last_updated": "2014-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MN",
"license": "1334",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Anoka, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.