Provider Demographics
NPI:1174411706
Name:FIDELIS FAMILY CARE
Entity type:Organization
Organization Name:FIDELIS FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:304-290-9462
Mailing Address - Street 1:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WV
Mailing Address - Zip Code:26354-0054
Mailing Address - Country:US
Mailing Address - Phone:304-681-4896
Mailing Address - Fax:
Practice Address - Street 1:250 TIMBERWOLF DR
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WV
Practice Address - Zip Code:26354-8185
Practice Address - Country:US
Practice Address - Phone:681-489-6221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-24
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care