Healthcare Provider Details

I. General information

NPI: 1649203605
Provider Name (Legal Business Name): FAIR OAKS EMERGENCY PHYSICIANS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 JOSEPH SIEWICK DR
FAIRFAX VA
22033-1709
US

IV. Provider business mailing address

PO BOX 734980
CHICAGO IL
60673-4980
US

V. Phone/Fax

Practice location:
  • Phone: 703-391-3996
  • Fax: 703-391-3094
Mailing address:
  • Phone: 703-631-1745
  • Fax: 703-662-4803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number StateVA

VIII. Authorized Official

Name: MR. JOHN JONES
Title or Position: GROUP HEAD
Credential: MD
Phone: 571-239-0788