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General NPI Number Information
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NPI Number | 1134672447
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Entity Type | Organization
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Legal Business Name | FAIRVIEW PHYSICIANS NETWORK, LLC
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Dates
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Enumeration Date | 08/03/2016
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Last Update Date | 08/04/2016
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Provider Practice Location Address
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Address Line | 1717 HIGH ST SUITE 4B
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City | HOPKINSVILLE
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State | KY
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Zip | 42240-6300
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Country | US
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Telephone | 270-985-1376
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Fax | 270-890-6036
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Provider Business Mailing Address
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Address Line | 102 W 18TH ST
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City | HOPKINSVILLE
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State | KY
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Zip | 42240-1961
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Country | US
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Telephone | 270-887-0100
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Fax | 270-707-2103
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | ERIC LEE
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Credential |
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Telephone | 270-887-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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