Organization
FAMILY CARE SPEC, INC., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES JOSEPH CHOUTEAU MD (OWNER)
(918) 786-6151
Entity
Organization
Contact information
Practice address
601 E 13TH ST STE C, GROVE, OK 74344-2962
(918) 786-6151
(918) 786-3483
Mailing address
601 E 13TH ST STE C, GROVE, OK 74344-2962
(918) 786-6151
(918) 786-3483
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
12203
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080029338
RAILROAD MEDICARE
OK
05
—
100738700A
—
OK
01
—
C08010
RAILROAD MEDICARE
OK
Enumeration date
11/06/2006
Last updated
01/14/2009
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