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General NPI Number Information
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NPI Number | 1194829812
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Entity Type | Organization
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Legal Business Name | FREDERICK MEDICAL CLINIC PSC
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 430 LIBERTY RD
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City | WEST LIBERTY
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State | KY
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Zip | 41472-2049
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Country | US
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Telephone | 606-743-3114
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Fax | 606-743-1404
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Provider Business Mailing Address
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Address Line | PO BOX 607
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City | WEST LIBERTY
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State | KY
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Zip | 41472-0607
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Country | US
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Telephone | 606-743-3114
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Fax | 606-743-1404
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Authorized Official
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Title or Position | ADMINISTRATION MEDICAL DIRECTOR
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Name | MR. JAMES DENZIL FREDERICK
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Credential | MD
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Telephone | 606-743-3114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 183940
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License Number State | KY
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