# CHARLES C CARTER MD DPH PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Charles C Carter MD DPh
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326095381
- **Authorized official:** DR. CHARLES C CARTER MD DPH (OWNER PHYSICIAN)
- **Authorized official phone:** (580) 480-1600

## Contact information

- **Practice address:** 1015 E BROADWAY ST, SUITE 102, ALTUS, OK 73521
- **Practice address phone:** (580) 480-1600
- **Practice address fax:** (580) 480-1601
- **Mailing address:** PO BOX 575, ALTUS, OK 73522-0575
- **Mailing address phone:** (580) 480-1600
- **Mailing address fax:** (580) 480-1601

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 19154 | OK | Yes |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 05/27/2006
- **Last updated:** 04/05/2022

## 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 |