# FAIRMONT PHYSICIANS INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790714228
- **Authorized official:** GEORGE BOYLES (TREASURER)
- **Authorized official phone:** (304) 367-7100

## Contact information

- **Practice address:** 211 MARION SQUARE, FAIRMONT, WV 26554
- **Practice address phone:** (304) 367-0043
- **Practice address fax:** (304) 367-9470
- **Mailing address:** PO BOX 2990, FAIRMONT, WV 26554
- **Mailing address phone:** (304) 367-0043
- **Mailing address fax:** (304) 367-9470

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |
| 208800000X | Urology Physician | — | NULL | Yes |
| 208800000X | Urology Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/30/2006
- **Last updated:** 03/17/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0009022000 | — | WV |