Provider Demographics
NPI:1265501274
Name:FAMILY CARE SPEC, INC., P.C.
Entity Type:Organization
Organization Name:FAMILY CARE SPEC, INC., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CHOUTEAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-786-6151
Mailing Address - Street 1:601 E 13TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74344-2962
Mailing Address - Country:US
Mailing Address - Phone:918-786-6151
Mailing Address - Fax:918-786-3483
Practice Address - Street 1:601 E 13TH ST STE C
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-2962
Practice Address - Country:US
Practice Address - Phone:918-786-6151
Practice Address - Fax:918-786-3483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12203207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK080029338OtherRAILROAD MEDICARE
OKC08010OtherRAILROAD MEDICARE
OK100738700AMedicaid
OKC08010OtherRAILROAD MEDICARE
OK0337370001Medicare NSC