Provider Demographics
NPI:1730112251
Name:FAIRVIEW HOSPITAL
Entity Type:Organization
Organization Name:FAIRVIEW HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-447-2000
Mailing Address - Street 1:PO BOX 1172
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01202-1172
Mailing Address - Country:US
Mailing Address - Phone:413-447-2000
Mailing Address - Fax:413-447-2803
Practice Address - Street 1:29 LEWIS AVE
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1713
Practice Address - Country:US
Practice Address - Phone:413-528-0790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2052282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1200542Medicaid
905627OtherTUFTS HEALTH PLAN INPT
220038OtherUNICARE MA
20850OtherBMC HEALTHNET PLAN
0373OtherMVP HEALTH CARE
MA1001728Medicaid
12257OtherHEALTH NEW ENGLAND
2222003810OtherBLUE CROSS OUTPATIENT
900245OtherTUFTS HEALTH PLAN OUTPT
992756OtherCONNECTICARE
2222003801OtherBLUE CROSS INPATIENT
2222003830OtherBLUE CROSS SDC
6300460OtherAETNA
900038OtherHARVARD PILGRIM HEALTH
H04359OtherOXFORD
10005803OtherCDPHP
MA1200542Medicaid
12257OtherHEALTH NEW ENGLAND