Provider Demographics
NPI:1922143098
Name:FAIRFAX HEALTHCARE PROPERTIES,L.L.C.
Entity Type:Organization
Organization Name:FAIRFAX HEALTHCARE PROPERTIES,L.L.C.
Other - Org Name:FAIRFAX MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHRISTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-642-3291
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:OK
Mailing Address - Zip Code:74637-0219
Mailing Address - Country:US
Mailing Address - Phone:918-642-3291
Mailing Address - Fax:918-642-3694
Practice Address - Street 1:HWY 18 & TAFT AVENUE
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:OK
Practice Address - Zip Code:74637-0219
Practice Address - Country:US
Practice Address - Phone:918-642-3291
Practice Address - Fax:918-642-3694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2274275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK37Z318Medicare Oscar/Certification