Provider Demographics
NPI:1962944991
Name:FAIRVIEW URGENT CARE, LLC
Entity type:Organization
Organization Name:FAIRVIEW URGENT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:F
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-580-7208
Mailing Address - Street 1:2150 WEHRLE DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7099
Mailing Address - Country:US
Mailing Address - Phone:716-580-7208
Mailing Address - Fax:
Practice Address - Street 1:4475 WEST VILLAGE PKWY
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294
Practice Address - Country:US
Practice Address - Phone:716-580-7208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-08
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care