Provider Demographics
NPI:1023452281
Name:FRYECARE BOONE, LLC
Entity type:Organization
Organization Name:FRYECARE BOONE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGIONAL CFO, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:O
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-265-5009
Mailing Address - Street 1:PO BOX 742408
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2104
Mailing Address - Country:US
Mailing Address - Phone:828-264-7222
Mailing Address - Fax:828-264-5485
Practice Address - Street 1:237 LONGVUE DR
Practice Address - Street 2:SUITE A
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5070
Practice Address - Country:US
Practice Address - Phone:828-264-7222
Practice Address - Fax:828-264-5485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-18
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty