Healthcare Provider Details

I. General information

NPI: 1811271901
Provider Name (Legal Business Name): FRIES COMMUNITY HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2011
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 CARROL DR
FRIES VA
24330-4532
US

IV. Provider business mailing address

PO BOX 453
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 Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

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