1376554006 NPI number — FAIRFAX HEALTHCARE PROPERTIES,LLC

Table of content: (NPI 1376554006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376554006 NPI number — FAIRFAX HEALTHCARE PROPERTIES,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAIRFAX HEALTHCARE PROPERTIES,LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FAIRFAX MEMORIAL HOSPITAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376554006
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HWY 18 & TAFT AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74637-0219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-642-3291
Provider Business Mailing Address Fax Number:
918-642-3694

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HWY 18 & TAFT AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74637-0219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-642-3291
Provider Business Practice Location Address Fax Number:
918-642-3694
Provider Enumeration Date:
08/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHRISTIAN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
918-642-3291

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  2274 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000370133001 . This is a "BCBS OKLAHOMA" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100700710A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: F37013301 . This is a "MEDICARE PART B (LEGACY)" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com