Healthcare Provider Details

I. General information

NPI: 1710260476
Provider Name (Legal Business Name): FRIES COMMUNITY HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 09/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 CARROLL DRIVE
FRIES VA
24330-4532
US

IV. Provider business mailing address

109 CARROLL DRIVE
FRIES VA
24330-0453
US

V. Phone/Fax

Practice location:
  • Phone: 276-744-3660
  • Fax:
Mailing address:
  • Phone: 276-744-3660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KELLY S VANDYKE
Title or Position: OWNER
Credential: MD
Phone: 276-744-3660