Organization Name: | FREDERICK MEDICAL CLINIC, PSC |
NPI Number: | 1194829812 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAMES DENZIL FREDERICK (ADMINISTRATION MEDICAL DIRECTOR) |
Mailing Address: | 430 Liberty Rd West Liberty |
State: | KY US |
Postal Code: | 414722049 |
Phone Number: | 6067433114 |
Fax Number: | 6067431404 |
NPI Enumeration Date: | 09/12/2006 |
NPI Last Update Date: | 04/11/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR1300X |
License Number: | 183940 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KY |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rural Health |
Taxonomy Definition: |