Provider Demographics
NPI:1992979181
Name:DERMOTT FAMILY PRACTICE, INC.
Entity type:Organization
Organization Name:DERMOTT FAMILY PRACTICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:E
Authorized Official - Last Name:VOGLER
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:870-538-3800
Mailing Address - Street 1:PO BOX 227
Mailing Address - Street 2:
Mailing Address - City:DERMOTT
Mailing Address - State:AR
Mailing Address - Zip Code:71638-0227
Mailing Address - Country:US
Mailing Address - Phone:870-538-3800
Mailing Address - Fax:
Practice Address - Street 1:105 N FREEMAN ST
Practice Address - Street 2:
Practice Address - City:DERMOTT
Practice Address - State:AR
Practice Address - Zip Code:71638-2304
Practice Address - Country:US
Practice Address - Phone:870-538-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-3872208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154472001Medicaid
AR154472001Medicaid
AR5M955Medicare PIN