Provider Demographics
NPI:1811121007
Name:FULL CARE MEDICAL CENTER PC
Entity type:Organization
Organization Name:FULL CARE MEDICAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:ABROKWAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:272-835-1122
Mailing Address - Street 1:P O BOX 356
Mailing Address - Street 2:
Mailing Address - City:CLINCHCO
Mailing Address - State:VA
Mailing Address - Zip Code:24226-0356
Mailing Address - Country:US
Mailing Address - Phone:276-835-1122
Mailing Address - Fax:276-835-8577
Practice Address - Street 1:163 NUMBER TEN ST
Practice Address - Street 2:
Practice Address - City:CLINCHCO
Practice Address - State:VA
Practice Address - Zip Code:24226
Practice Address - Country:US
Practice Address - Phone:276-835-1122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-04
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty