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Organization
CHARLES C CARTER MD DPH PLLC
Active
Organization
CHARLES C CARTER MD DPH PLLC
Active
Other names
Charles C Carter MD DPh
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES C CARTER MD DPH (OWNER PHYSICIAN)
(580) 480-1600
Entity
Organization
Contact information
Practice address
1015 E BROADWAY ST, SUITE 102, ALTUS, OK 73521
(580) 480-1600
(580) 480-1601
Mailing address
PO BOX 575, ALTUS, OK 73522-0575
(580) 480-1600
(580) 480-1601
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
19154
OK
261QR1300X
Rural Health Clinic/Center
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100116810D
—
OK
05
—
100116810E
—
OK
01
—
19154
OK STATE LICENSE #
OK
05
—
200113300A
—
OK
01
—
203705843
TRICARE/HUMANA PROVIDER #
OK
01
—
37D1053611
CLIA WAIVED
OK
01
—
445440041004
BCBS BILLING #
OK
01
—
C-8500
ARKANSAS STATE LICENSE #
AR
Enumeration date
05/27/2006
Last updated
04/05/2022
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