Provider Demographics
| NPI: | 1821385329 |
|---|---|
| Name: | FAIRVIEW PHYSICIANS NETWORK LLC |
| Entity Type: | Organization |
| Organization Name: | FAIRVIEW PHYSICIANS NETWORK LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PRESIDENT/CEO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | ERIC |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | LEE |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 270-887-0100 |
| Mailing Address - Street 1: | PO BOX 990 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | HOPKINSVILLE |
| Mailing Address - State: | KY |
| Mailing Address - Zip Code: | 42241-0990 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 270-707-2100 |
| Mailing Address - Fax: | 270-707-2103 |
| Practice Address - Street 1: | 102 W 18TH ST |
| Practice Address - Street 2: | |
| Practice Address - City: | HOPKINSVILLE |
| Practice Address - State: | KY |
| Practice Address - Zip Code: | 42240-1961 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 270-707-2100 |
| Practice Address - Fax: | 270-707-2103 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2011-07-05 |
| Last Update Date: | 2020-12-22 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
| No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
| No | 207RX0202X | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | Group - Multi-Specialty |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | Group - Multi-Specialty |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
| No | 363LA2200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | Group - Multi-Specialty |
| No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| KY | 7100172970 | Medicaid | |
| K011200 | Medicare PIN |
