Provider Demographics
NPI:1538504196
Name:FAIRFIELD MEDICAL CENTER LLP
Entity Type:Organization
Organization Name:FAIRFIELD MEDICAL CENTER LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:S
Authorized Official - Last Name:KWAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-304-5100
Mailing Address - Street 1:15040 FAIRFIELD VILLAGE SQUARE DR STE 150
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-7901
Mailing Address - Country:US
Mailing Address - Phone:281-304-5100
Mailing Address - Fax:281-304-5191
Practice Address - Street 1:15040 FAIRFIELD VILLAGE SQUARE DR
Practice Address - Street 2:STE 150
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-5952
Practice Address - Country:US
Practice Address - Phone:281-304-5100
Practice Address - Fax:281-304-5191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2018-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty