Healthcare Provider Details

I. General information

NPI: 1780619858
Provider Name (Legal Business Name): FAIRLESS HILLS MEDICAL CTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 11/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N OXFORD VALLEY ROAD STE 201
FAIRLESS HILLS PA
19030
US

IV. Provider business mailing address

333 N OXFORD VALLEY ROAD STE 201
FAIRLESS HILLS PA
19030
US

V. Phone/Fax

Practice location:
  • Phone: 215-946-3417
  • Fax: 215-946-3417
Mailing address:
  • Phone: 215-946-1500
  • Fax: 215-946-3417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. HOWARD F FERGUSON
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 215-946-1500