Provider Demographics
NPI:1417041278
Name:FAIRMOUNT CENTER, P.A.
Entity Type:Organization
Organization Name:FAIRMOUNT CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:21-742-9310
Mailing Address - Street 1:2921 FAIRMOUNT ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-1456
Mailing Address - Country:US
Mailing Address - Phone:214-742-9310
Mailing Address - Fax:214-320-2119
Practice Address - Street 1:2921 FAIRMOUNT ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-1456
Practice Address - Country:US
Practice Address - Phone:214-742-9310
Practice Address - Fax:214-320-2119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007301261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center