Provider Demographics
NPI:1134253206
Name:FAIRWAY GOLF CARS, INC.
Entity type:Organization
Organization Name:FAIRWAY GOLF CARS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MURCHISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-223-8211
Mailing Address - Street 1:150 CRYSTAL ST
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-2731
Mailing Address - Country:US
Mailing Address - Phone:847-516-5460
Mailing Address - Fax:847-516-5462
Practice Address - Street 1:150 CRYSTAL ST
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013-2731
Practice Address - Country:US
Practice Address - Phone:847-516-5460
Practice Address - Fax:847-516-5462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05621184OtherBLUE CROSS BLUE SHIELD
IL05621184OtherBLUE CROSS BLUE SHIELD
IL1052390001Medicare ID - Type Unspecified