Healthcare Provider Details

I. General information

NPI: 1174411706
Provider Name (Legal Business Name): FIDELIS FAMILY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3527 FAIRMONT AVE
FAIRMONT WV
26554-3474
US

IV. Provider business mailing address

3527 FAIRMONT AVE
FAIRMONT WV
26554-3474
US

V. Phone/Fax

Practice location:
  • Phone: 681-489-6221
  • Fax:
Mailing address:
  • Phone: 681-489-6221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JORDAN CAMPBELL
Title or Position: OWNER
Credential: PA-C
Phone: 304-290-9462