Provider Demographics
NPI:1093769044
Name:FAIRVIEW PARK, LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:FAIRVIEW PARK, LIMITED PARTNERSHIP
Other - Org Name:FAIRVIEW PARK HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:NOBLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-274-3103
Mailing Address - Street 1:200 INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2981
Mailing Address - Country:US
Mailing Address - Phone:478-275-2000
Mailing Address - Fax:478-272-0211
Practice Address - Street 1:200 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2981
Practice Address - Country:US
Practice Address - Phone:478-275-2000
Practice Address - Fax:478-272-0211
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAIRVIEW PARK, LIMITED PARTNERSHIP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-22
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
11T125Medicare Oscar/Certification