Provider Demographics
NPI:1104253327
Name:MEDICAL DIRECT CARE, PLC
Entity type:Organization
Organization Name:MEDICAL DIRECT CARE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:MARCEL
Authorized Official - Last Name:FRYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-221-0902
Mailing Address - Street 1:190 HATCHER LANE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040
Mailing Address - Country:US
Mailing Address - Phone:931-221-0902
Mailing Address - Fax:931-221-0602
Practice Address - Street 1:190 HATCHER LANE
Practice Address - Street 2:SUITE B
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040
Practice Address - Country:US
Practice Address - Phone:931-221-0902
Practice Address - Fax:931-221-0602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty