Healthcare Provider Details

I. General information

NPI: 1174776207
Provider Name (Legal Business Name): FAIRVIEW CLINIC PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 E MILLER RD
FAIRVIEW MI
48621-8731
US

IV. Provider business mailing address

1910 E MILLER RD
FAIRVIEW MI
48621-8731
US

V. Phone/Fax

Practice location:
  • Phone: 989-848-5644
  • Fax: 989-848-7411
Mailing address:
  • Phone: 989-848-5644
  • Fax: 989-848-7411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHERYL HENRY
Title or Position: FNP-BC
Credential:
Phone: 989-848-5644