Provider Demographics
NPI:1902957681
Name:S. CASEY FRYER DO, PLLC
Entity Type:Organization
Organization Name:S. CASEY FRYER DO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:S. CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRYER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-842-8060
Mailing Address - Street 1:PO BOX 6813
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-0920
Mailing Address - Country:US
Mailing Address - Phone:304-233-2455
Mailing Address - Fax:304-233-6073
Practice Address - Street 1:1511 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330
Practice Address - Country:US
Practice Address - Phone:304-842-8060
Practice Address - Fax:304-842-9064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9352861Medicare ID - Type Unspecified