Healthcare Provider Details

I. General information

NPI: 1376554006
Provider Name (Legal Business Name): FAIRFAX HEALTHCARE PROPERTIES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 18 & TAFT AVENUE
FAIRFAX OK
74637-0219
US

IV. Provider business mailing address

HWY 18 & TAFT AVENUE
FAIRFAX OK
74637-0219
US

V. Phone/Fax

Practice location:
  • Phone: 918-642-3291
  • Fax: 918-642-3694
Mailing address:
  • Phone: 918-642-3291
  • Fax: 918-642-3694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number2274
License Number StateOK

VIII. Authorized Official

Name: MR. MICHAEL CHRISTIAN
Title or Position: CEO
Credential:
Phone: 918-642-3291