Provider Demographics
NPI:1285688234
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02713293Medicaid
MT0413831Medicaid
OH2478439Medicaid
FL912418700Medicaid
SC11084AMedicaid
GA000001141AMedicaid
CT003123479Medicaid
AR158180105Medicaid
KS200332480AMedicaid
MI304845784Medicaid
GA153OtherBLUE CROSS
LA1702820Medicaid
TN4022419OtherBLUECARE
ID807291800Medicaid
166597300OtherDEPT OF LABOR
NJ4101901Medicaid
MI304845784Medicaid