Provider Demographics
NPI:1336137702
Name:FAIRVIEW HEALTH ASSOCIATES INC
Entity Type:Organization
Organization Name:FAIRVIEW HEALTH ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:SHANK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-872-5090
Mailing Address - Street 1:PO BOX 1029
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-0139
Mailing Address - Country:US
Mailing Address - Phone:304-872-5090
Mailing Address - Fax:304-872-0636
Practice Address - Street 1:350 FAIRVIEW HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-1085
Practice Address - Country:US
Practice Address - Phone:304-872-5090
Practice Address - Fax:304-872-0636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0202164000Medicaid
WV0202164000Medicaid
WV0202164000Medicaid