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General NPI Number Information
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NPI Number | 1316981657
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Entity Type | Organization
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Legal Business Name | FAIRVIEW REGIONAL MEDICAL CENTER AUTHORITY
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 03/11/2015
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Provider Practice Location Address
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Address Line | 519 E STATE RD
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City | FAIRVIEW
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State | OK
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Zip | 73737-1458
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Country | US
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Telephone | 580-227-2585
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Fax | 580-227-2882
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Provider Business Mailing Address
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Address Line | PO BOX 548
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City | FAIRVIEW
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State | OK
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Zip | 73737-0548
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Country | US
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Telephone | 580-227-2585
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Fax | 580-227-2882
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ROGER KNAK
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Credential |
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Telephone | 580-227-3721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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