Provider Demographics
NPI:1134672447
Name:FAIRVIEW PHYSICIANS NETWORK, LLC
Entity Type:Organization
Organization Name:FAIRVIEW PHYSICIANS NETWORK, LLC
Other - Org Name:JENNIE STUART MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-887-0100
Mailing Address - Street 1:102 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-1961
Mailing Address - Country:US
Mailing Address - Phone:270-887-0100
Mailing Address - Fax:270-707-2103
Practice Address - Street 1:1717 HIGH ST
Practice Address - Street 2:SUITE 4B
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-6300
Practice Address - Country:US
Practice Address - Phone:270-985-1376
Practice Address - Fax:270-890-6036
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JENNIE STUART MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-03
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health