Provider Demographics
NPI:1639463722
Name:FAIRMONT PHYSICIANS, INC
Entity Type:Organization
Organization Name:FAIRMONT PHYSICIANS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-367-7315
Mailing Address - Street 1:PO BOX 2990
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26555-2990
Mailing Address - Country:US
Mailing Address - Phone:304-367-0387
Mailing Address - Fax:304-367-9470
Practice Address - Street 1:51 SOUTHLAND DR
Practice Address - Street 2:SUITE 1200
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-2244
Practice Address - Country:US
Practice Address - Phone:304-363-2018
Practice Address - Fax:304-333-2456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty