MEDICARE: PATSY J FAIRCHILD PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	01218	WV
2	363A00000X	Physician Assistant	387	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01218	OTHER	WV	LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	001969193	OTHER	WV	MS BCBS

General Provider Information

NPI Number	:	1649368119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATSY J FAIRCHILD PA-C

Provider Business Mailing Address
First Line	:	PO BOX 337
Second Line	:
City	:	SCARBRO
State	:	WV
Zip	:	25917-0337
Country	:	US
Telephone Number	:	304-469-2905
Fax Number	:	304-465-3180

Provider Business Practice Location Address
First Line	:	221 W MAPLE AVE
Second Line	:
City	:	FAYETTEVILLE
State	:	WV
Zip	:	25840-1413
Country	:	US
Telephone Number	:	304-574-3960
Fax Number	:	304-574-2179

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	09/07/2011

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Directions to “ PATSY J FAIRCHILD PA-C” Practice Location

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