Provider Demographics
NPI:1982233656
Name:RURAL WELLNESS FAIRFAX INC
Entity Type:Organization
Organization Name:RURAL WELLNESS FAIRFAX INC
Other - Org Name:THE PAWNEE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:PUSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-645-2321
Mailing Address - Street 1:361 HOSPITAL RD STE 528
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3526
Mailing Address - Country:US
Mailing Address - Phone:949-322-4337
Mailing Address - Fax:
Practice Address - Street 1:535 6TH ST
Practice Address - Street 2:
Practice Address - City:PAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74058-2542
Practice Address - Country:US
Practice Address - Phone:918-762-3942
Practice Address - Fax:918-762-4675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-05
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health