Provider Demographics
NPI:1174776207
Name:FAIRVIEW CLINIC PLC
Entity type:Organization
Organization Name:FAIRVIEW CLINIC PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-848-5644
Mailing Address - Street 1:1910 E MILLER RD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48621-8731
Mailing Address - Country:US
Mailing Address - Phone:989-848-5644
Mailing Address - Fax:989-848-7411
Practice Address - Street 1:1910 E MILLER RD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:MI
Practice Address - Zip Code:48621-8731
Practice Address - Country:US
Practice Address - Phone:989-848-5644
Practice Address - Fax:989-848-7411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-03
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
238906Medicare Oscar/Certification