1285688234 NPI number — FAIRVIEW PARK, LIMITED PARTNERSHIP

Table of content: (NPI 1285688234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285688234 NPI number — FAIRVIEW PARK, LIMITED PARTNERSHIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAIRVIEW PARK, LIMITED PARTNERSHIP
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:
6
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:
1285688234
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 INDUSTRIAL BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUBLIN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31021-2981
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-275-2000
Provider Business Mailing Address Fax Number:
478-272-0211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 INDUSTRIAL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUBLIN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31021-2981
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-275-2000
Provider Business Practice Location Address Fax Number:
478-272-0211
Provider Enumeration Date:
05/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NOBLES
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
478-274-3103

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000001141A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 153 . This is a "BLUE CROSS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 166597300 . This is a "DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2478439 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 912418700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200332480A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11084A , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 158180105 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 304845784 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4022419 . This is a "BLUECARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 003123479 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0413831 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02713293 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4101901 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1702820 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 807291800 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 108359200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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