Provider Demographics
NPI:1164460135
Name:FAIRWAY MEDICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:FAIRWAY MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:Q
Authorized Official - Last Name:BRICKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-264-6511
Mailing Address - Street 1:144 S 8TH ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-2755
Mailing Address - Country:US
Mailing Address - Phone:717-264-6511
Mailing Address - Fax:717-264-1081
Practice Address - Street 1:144 S 8TH ST
Practice Address - Street 2:SUITE 111
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-2767
Practice Address - Country:US
Practice Address - Phone:717-264-6511
Practice Address - Fax:717-264-1081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009928520001Medicaid
PAB32668Medicare UPIN
PA0009928520001Medicaid
PAB32668Medicare UPIN
PA511654Medicare PIN