1184693053 NPI number — FAIRVIEW CLINIC, P.C.

Table of content: DR. STEVEN G. MITCHELL D.D.S. (NPI 1457367468)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184693053 NPI number — FAIRVIEW CLINIC, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAIRVIEW CLINIC, P.C.
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:
Provider Other Organization Name Type Code:
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:
1184693053
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1118 ROSS CLARK CIR
Provider Second Line Business Mailing Address:
SUITE 303
Provider Business Mailing Address City Name:
DOTHAN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36301-3001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-794-3192
Provider Business Mailing Address Fax Number:
334-792-7513

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1118 ROSS CLARK CIR
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
DOTHAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36301-3001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-794-3192
Provider Business Practice Location Address Fax Number:
334-792-7513
Provider Enumeration Date:
03/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
YUREVICH
Authorized Official First Name:
DEBBIE
Authorized Official Middle Name:
I
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
334-794-3192

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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