# FREDERICKTOWN FAMILY PRACTICE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114060472
- **Authorized official:** MS. AMANDA BOWERS (OFFICE MANAGER)
- **Authorized official phone:** (740) 694-2110

## Contact information

- **Practice address:** 16361 VILLAGE PKWY, FREDERICKTOWN, OH 43019-9585
- **Practice address phone:** (740) 694-2110
- **Practice address fax:** (740) 694-2127
- **Mailing address:** 16361 VILLAGE PKWY, FREDERICKTOWN, OH 43019-9585
- **Mailing address phone:** (740) 694-2110
- **Mailing address fax:** (740) 694-2127

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/15/2007
- **Last updated:** 07/20/2010