Provider Demographics
NPI:1710260476
Name:FRIES COMMUNITY HEALTH CARE INC
Entity Type:Organization
Organization Name:FRIES COMMUNITY HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:VANDYKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-744-3660
Mailing Address - Street 1:109 CARROLL DRIVE
Mailing Address - Street 2:
Mailing Address - City:FRIES
Mailing Address - State:VA
Mailing Address - Zip Code:24330-0453
Mailing Address - Country:US
Mailing Address - Phone:276-744-3660
Mailing Address - Fax:
Practice Address - Street 1:109 CARROLL DRIVE
Practice Address - Street 2:
Practice Address - City:FRIES
Practice Address - State:VA
Practice Address - Zip Code:24330-4532
Practice Address - Country:US
Practice Address - Phone:276-744-3660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-20
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty