Provider Demographics
NPI:1780619858
Name:FAIRLESS HILLS MEDICAL CTR
Entity type:Organization
Organization Name:FAIRLESS HILLS MEDICAL CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-946-1500
Mailing Address - Street 1:333 N OXFORD VALLEY ROAD
Mailing Address - Street 2:STE 201
Mailing Address - City:FAIRLESS HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19030
Mailing Address - Country:US
Mailing Address - Phone:215-946-1500
Mailing Address - Fax:215-946-3417
Practice Address - Street 1:333 N OXFORD VALLEY ROAD
Practice Address - Street 2:STE 201
Practice Address - City:FAIRLESS HILLS
Practice Address - State:PA
Practice Address - Zip Code:19030
Practice Address - Country:US
Practice Address - Phone:215-946-3417
Practice Address - Fax:215-946-3417
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED PRIMARY CARE PHYSICIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-11
Last Update Date:2010-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
038944N6RMedicare ID - Type Unspecified