Provider Demographics
NPI:1508115718
Name:FAIRWAY FAMILY MEDICINE-PRIMARY CARE, PLLC
Entity Type:Organization
Organization Name:FAIRWAY FAMILY MEDICINE-PRIMARY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HONG
Authorized Official - Middle Name:
Authorized Official - Last Name:XIAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-878-9480
Mailing Address - Street 1:4100 FAIRWAY DR
Mailing Address - Street 2:320
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-6525
Mailing Address - Country:US
Mailing Address - Phone:972-236-7608
Mailing Address - Fax:
Practice Address - Street 1:4100 FAIRWAY DR
Practice Address - Street 2:320
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-6525
Practice Address - Country:US
Practice Address - Phone:972-236-7608
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3196261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8413B6Medicare PIN
TXH53974Medicare UPIN