Basic Information
| Provider Information | |||||||||
| NPI: | 1780619858 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAIRLESS HILLS MEDICAL CTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 N OXFORD VALLEY ROAD | ||||||||
| Address2: | STE 201 | ||||||||
| City: | FAIRLESS HILLS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159461500 | ||||||||
| FaxNumber: | 2159463417 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 N OXFORD VALLEY ROAD | ||||||||
| Address2: | STE 201 | ||||||||
| City: | FAIRLESS HILLS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159463417 | ||||||||
| FaxNumber: | 2159463417 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 11/26/2010 | ||||||||
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| AuthorizedOfficialLastName: | FERGUSON | ||||||||
| AuthorizedOfficialFirstName: | HOWARD | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2159461500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ADVANCED PRIMARY CARE PHYSICIANS | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.