Provider Demographics
NPI:1275827560
Name:FAIRVIEW BAPTIST CHURCH
Entity Type:Organization
Organization Name:FAIRVIEW BAPTIST CHURCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PASTOR
Authorized Official - Prefix:
Authorized Official - First Name:DR. JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-235-8820
Mailing Address - Street 1:PO BOX 36188
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73136-2188
Mailing Address - Country:US
Mailing Address - Phone:405-209-6750
Mailing Address - Fax:
Practice Address - Street 1:1700 NE 7TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-2817
Practice Address - Country:US
Practice Address - Phone:405-209-6750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11111111111251B00000X
OK1111111111111251B00000X
251V00000X, 305S00000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No251B00000XAgenciesCase Management
No251V00000XAgenciesVoluntary or Charitable
No305S00000XManaged Care OrganizationsPoint of Service