Provider Demographics
NPI:1285037416
Name:FAIRVIEW REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:FAIRVIEW REGIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:KNAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-227-1370
Mailing Address - Street 1:519 E STATE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OK
Mailing Address - Zip Code:73737-1458
Mailing Address - Country:US
Mailing Address - Phone:580-227-2585
Mailing Address - Fax:580-227-1382
Practice Address - Street 1:519 E STATE RD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:OK
Practice Address - Zip Code:73737-1458
Practice Address - Country:US
Practice Address - Phone:580-227-2585
Practice Address - Fax:580-227-1382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20436261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1841252483OtherNPI