Provider Demographics
NPI:1639558034
Name:FRYECARE VALDESE, LLC
Entity Type:Organization
Organization Name:FRYECARE VALDESE, LLC
Other - Org Name:FRYECARE INTERNAL MEDICINE - HICKORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP, OUTPATIENT SERVICES, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:BURTNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-893-2902
Mailing Address - Street 1:PO BOX 743547
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3547
Mailing Address - Country:US
Mailing Address - Phone:828-449-8458
Mailing Address - Fax:828-323-8348
Practice Address - Street 1:915 TATE BLVD SE STE 186
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4042
Practice Address - Country:US
Practice Address - Phone:828-449-8458
Practice Address - Fax:828-323-8348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-19
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty