Mr Charles Robert Mutch, PA is a medicare enrolled "Family Medicine" physician in Ft. Gibson, Oklahoma. His current practice location is
104 Lone Oak Circle, Ft. Gibson, Oklahoma. You can reach out to his office (for appointments etc.) via phone at
(918) 478-2101.
Mr Charles Robert Mutch is licensed to practice in Oklahoma (license number 39) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1831206671.
Physician's Profile
Full Name | Mr Charles Robert Mutch |
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Gender | Male |
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Speciality | Family Medicine |
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Location | 104 Lone Oak Circle, Ft. Gibson, Oklahoma |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1831206671
- Provider Enumeration Date: 08/25/2006
- Last Update Date: 05/13/2010
Medicare PECOS Information:
- PECOS PAC ID: 7214987114
- Enrollment ID: I20050319000003
Medical Identifiers
Medical identifiers for Mr Charles Robert Mutch such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1831206671 | NPI | - | NPPES |
100015570A | Medicaid | OK | |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
207Q00000X | Family Medicine | 39 (Oklahoma) | Primary |
2083X0100X | Preventive Medicine - Occupational Medicine | 39 (Oklahoma) | Secondary |
247100000X | Radiologic Technologist | 39 (Oklahoma) | Secondary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Charles Robert Mutch is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Mr Charles Robert Mutch, PA Po Box 1008, Tahlequah, OK 74465-1008 Ph: (918) 478-2101 | Mr Charles Robert Mutch, PA 104 Lone Oak Circle, Ft. Gibson, OK 74434 Ph: (918) 478-2101 |
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