Provider Demographics
NPI:1356346357
Name:FAIRMONT HOME EQUIPMENT & SUPPLY COMPANY
Entity type:Organization
Organization Name:FAIRMONT HOME EQUIPMENT & SUPPLY COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LANCASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-282-2700
Mailing Address - Street 1:PO BOX 580
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-0580
Mailing Address - Country:US
Mailing Address - Phone:304-285-2700
Mailing Address - Fax:304-285-2704
Practice Address - Street 1:600 BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1124
Practice Address - Country:US
Practice Address - Phone:304-285-2700
Practice Address - Fax:304-285-2704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9100036000Medicaid
WV1249110001Medicare NSC