Basic Information
| Provider Information | |||||||||
| NPI: | 1316129943 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAIRVIEW EMERGENCY PHYSICIANS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 42057 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191012057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154425000 | ||||||||
| FaxNumber: | 2159572875 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 FAIRVIEW HEIGHTS RD | ||||||||
| Address2: | |||||||||
| City: | SUMMERSVILLE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 266519308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3048728991 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2007 | ||||||||
| LastUpdateDate: | 12/05/2007 | ||||||||
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| AuthorizedOfficialLastName: | BYRNE | ||||||||
| AuthorizedOfficialFirstName: | GREGORY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8003550808 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.