Provider Demographics
NPI:1104158401
Name:FORT CHISWELL FAMILY CARE, PLLC
Entity type:Organization
Organization Name:FORT CHISWELL FAMILY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:STOKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-637-6641
Mailing Address - Street 1:791 FORT CHISWELL RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MAX MEADOWS
Mailing Address - State:VA
Mailing Address - Zip Code:24360-4139
Mailing Address - Country:US
Mailing Address - Phone:276-637-6641
Mailing Address - Fax:276-637-6741
Practice Address - Street 1:791 FORT CHISWELL RD
Practice Address - Street 2:SUITE A
Practice Address - City:MAX MEADOWS
Practice Address - State:VA
Practice Address - Zip Code:24360-4139
Practice Address - Country:US
Practice Address - Phone:276-637-6641
Practice Address - Fax:276-637-6741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-11
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty