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Organization

FAIRWAY PRIMARY CARE, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MISS MELISSA ANN KIFER (OFFICE COORDINATOR)
(814) 942-9494
Entity
Organization

Contact information

Practice address
2950 FAIRWAY DR, SUITE 2, ALTOONA, PA 16602-4457
(814) 942-9494
(814) 942-4399
Mailing address
2950 FAIRWAY DR, SUITE 2, ALTOONA, PA 16602-4457
(814) 942-9494
(814) 942-4399

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
OS010770L
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
DB9443
RAILROAD MEDICARE
PA
Enumeration date
03/08/2007
Last updated
11/14/2007
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