Organization
AVALA PHYSICIAN NETWORK, LLC
Active
Parent organization
FAIRWAY MEDICAL CENTER, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
FAIRWAY MEDICAL CENTER, LLC
Authorized official
BROOKE CUMMINGS (CFO)
(985) 801-6247
Entity
Organization
Contact information
Practice address
1200 PINNACLE PKWY STE 3, COVINGTON, LA 70433-9169
(985) 674-1700
(985) 674-1722
Mailing address
67252 INDUSTRY LN, COVINGTON, LA 70433-8704
(985) 888-1182
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
12/15/2020
Last updated
05/06/2026
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