=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467985556
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHARLES A PEARROW DO PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2017
-----------------------------------------------------
Last Update Date | 05/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 508 COUNTRY CHARM RD
-----------------------------------------------------
City | MOUNTAIN VIEW
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72560-6501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-269-3838
-----------------------------------------------------
Fax | 870-213-0522
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 508 COUNTRY CHARM RD
-----------------------------------------------------
City | MOUNTAIN VIEW
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72560-6501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-213-0522
-----------------------------------------------------
Fax | 870-999-0243
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINIC ADMIN
-----------------------------------------------------
Name | EVANGELINE ISABELLA PEARROW
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 870-213-0522
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 204D00000X
-----------------------------------------------------
Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
-----------------------------------------------------
License Number | E-9948
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | E-9948
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------