MEDICARE: FAIRVIEW HEALTH ASSOCIATES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336137702
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAIRVIEW HEALTH ASSOCIATES INC

Provider Business Mailing Address
First Line	:	PO BOX 1029
Second Line	:
City	:	SUMMERSVILLE
State	:	WV
Zip	:	26651-0139
Country	:	US
Telephone Number	:	304-872-5090
Fax Number	:	304-872-0636

Provider Business Practice Location Address
First Line	:	350 FAIRVIEW HEIGHTS RD
Second Line	:
City	:	SUMMERSVILLE
State	:	WV
Zip	:	26651-1085
Country	:	US
Telephone Number	:	304-872-5090
Fax Number	:	304-872-0636

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN STEPHEN SHANK
Credential	:	MD
Telephone Number	:	304-872-5090

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	03/27/2015

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