Basic Information
| Provider Information | |||||||||
| NPI: | 1659923316 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAIRVIEW PHYSICIANS NETWORK LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 102 W 18TH ST | ||||||||
| Address2: | |||||||||
| City: | HOPKINSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 422401961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707072100 | ||||||||
| FaxNumber: | 2707072103 | ||||||||
| Practice Location | |||||||||
| Address1: | 102 W 18TH ST | ||||||||
| Address2: | |||||||||
| City: | HOPKINSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 422401961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707072100 | ||||||||
| FaxNumber: | 2707072103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2019 | ||||||||
| LastUpdateDate: | 07/12/2019 | ||||||||
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| AuthorizedOfficialLastName: | BAILEY | ||||||||
| AuthorizedOfficialFirstName: | AUTUMN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGED CARE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2708870100 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | JENNIE STUART MEDICAL CENTER | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207RX0202X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
No ID Information.