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Organization

FAMILY HEALTHCARE OF WYTHEVILLE, PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LARISSA SHAE PARKS (OFFICE MANAGER)
(276) 227-0200
Entity
Organization

Contact information

Practice address
1040 HOLSTON RD, WYTHEVILLE, VA 24382-4107
(276) 227-0200
(276) 227-0202
Mailing address
1040 HOLSTON RD, WYTHEVILLE, VA 24382-4107
(276) 227-0200
(276) 227-0202

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0102202346
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1346474707
VA
Enumeration date
05/13/2009
Last updated
03/02/2021
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