Healthcare Provider Details

I. General information

NPI: 1275827560
Provider Name (Legal Business Name): FAIRVIEW BAPTIST CHURCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2011
Last Update Date: 06/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 NE 7TH ST
OKLAHOMA CITY OK
73117-2817
US

IV. Provider business mailing address

PO BOX 36188
OKLAHOMA CITY OK
73136-2188
US

V. Phone/Fax

Practice location:
  • Phone: 405-209-6750
  • Fax:
Mailing address:
  • Phone: 405-209-6750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number11111111111
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number1111111111111
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN REED
Title or Position: PASTOR
Credential:
Phone: 405-235-8820