Healthcare Provider Details

I. General information

NPI: 1659597698
Provider Name (Legal Business Name): CHARLES VERMONT, M.D., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 06/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 WEST FIRST NORTH
PRESCOTT AR
71857
US

IV. Provider business mailing address

1480 WEST FIRST NORTH
PRESCOTT AR
71857
US

V. Phone/Fax

Practice location:
  • Phone: 870-887-2669
  • Fax: 870-887-5373
Mailing address:
  • Phone: 870-887-2669
  • Fax: 870-887-5373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberC7159
License Number StateAR

VIII. Authorized Official

Name: DR. CHARLES VERMONT
Title or Position: CEO
Credential: M.D.
Phone: 870-887-2669