MEDICARE: CHARLES A. VERMONT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	C7159	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080103771	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	127710000	OTHER	AR	QUAL CHOICE

General Provider Information

NPI Number	:	1912904251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES A. VERMONT M.D.

Provider Business Mailing Address
First Line	:	PO BOX 550
Second Line	:
City	:	PRESCOTT
State	:	AR
Zip	:	71857-0550
Country	:	US
Telephone Number	:	870-887-2669
Fax Number	:	870-887-5373

Provider Business Practice Location Address
First Line	:	1480 W 1ST ST N
Second Line	:
City	:	PRESCOTT
State	:	AR
Zip	:	71857-3339
Country	:	US
Telephone Number	:	870-887-2669
Fax Number	:	870-887-5373

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	06/06/2008

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Directions to “ CHARLES A. VERMONT M.D.” Practice Location

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