Healthcare Provider Details

I. General information

NPI: 1790314466
Provider Name (Legal Business Name): RURAL WELLNESS FAIRFAX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2020
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 HOSPITAL RD
FAIRFAX OK
74637-5084
US

IV. Provider business mailing address

2524 N BROADWAY
EDMOND OK
73034-4172
US

V. Phone/Fax

Practice location:
  • Phone: 918-642-8827
  • Fax: 918-642-3298
Mailing address:
  • Phone: 949-322-4337
  • Fax:

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: ELIZABETH J PUSEY
Title or Position: PRESIDENT
Credential:
Phone: 949-645-2321