| Charles C Carter Md Dph Pllc | |
|
1015 E Broadway St Suite 102 Altus OK 73521 | |
| (580) 480-1600 | |
| (580) 480-1601 |
| Full Name | Charles C Carter Md Dph Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 1015 E Broadway St, Altus, Oklahoma |
| Authorized Official Name and Position | Charles C Carter (OWNER PHYSICIAN) |
| Authorized Official Contact | 5804801600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Charles C Carter Md Dph Pllc Po Box 575 Altus OK 73522-0575 Ph: (580) 480-1600 | Charles C Carter Md Dph Pllc 1015 E Broadway St Suite 102 Altus OK 73521 Ph: (580) 480-1600 |
| NPI Number | 1326095381 |
|---|---|
| Provider Enumeration Date | 05/27/2006 |
| Last Update Date | 04/05/2022 |
| Medicare PECOS PAC ID | 1153422530 |
|---|---|
| Medicare Enrollment ID | O20070730000480 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326095381 | NPI | - | NPPES |
| 100116810E | Medicaid | OK | |
| 200113300A | Medicaid | OK | |
| 445440041004 | Other | OK | BCBS BILLING # |
| 19154 | Other | OK | OK STATE LICENSE # |
| 100116810D | Medicaid | OK | |
| 37D1053611 | Other | OK | CLIA WAIVED |
| C-8500 | Other | AR | ARKANSAS STATE LICENSE # |
| 203705843 | Other | OK | TRICARE/HUMANA PROVIDER # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 19154 (Oklahoma) | Primary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Secondary |
| Provider Name | Charles C Carter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730129750 PECOS PAC ID: 3779540356 Enrollment ID: I20041215000487 |
| Provider Name | Frances Elizabeth Barber |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356824411 PECOS PAC ID: 1850638255 Enrollment ID: I20190123002368 |
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