Provider Demographics
NPI:1174689467
Name:FAIRVIEW HOSPITAL
Entity Type:Organization
Organization Name:FAIRVIEW HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-447-2000
Mailing Address - Street 1:PO BOX 1172
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01202-1172
Mailing Address - Country:US
Mailing Address - Phone:413-528-0790
Mailing Address - Fax:413-528-8615
Practice Address - Street 1:29 LEWIS AVE
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1713
Practice Address - Country:US
Practice Address - Phone:413-528-0790
Practice Address - Fax:413-528-8615
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAIRVIEW HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-29
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2052275N00000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
0373OtherMVP
MA2222003801OtherBLUE CROSS INPT
MA2222003810OtherBLUE CROSS OUTPT
MA1001728Medicaid
MA20850OtherBMC HEALTH NET PLAN
221302OtherHUMANA
900038OtherHARVARD PILGRIM HEALTH
MA220038OtherUNICARE MA EMPLOYEE GIC
MA2222003830OtherBLUE CROSS SDC
6300460OtherAETNA
10005803OtherCDPHP
905627OtherTUFTS HEALTH PLAN INPT
992756OtherCONNECTICARE
MA1200542Medicaid
12257OtherHEALTH NEW ENGLAND
900245OtherTUFTS HEALTH PLAN OUTPT
HO4359OtherOXFORD
MA2222003810OtherBLUE CROSS OUTPT