Provider Demographics
NPI:1780814236
Name:FAIRWAY MEDICAL SERVICES,INC
Entity type:Organization
Organization Name:FAIRWAY MEDICAL SERVICES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLDOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-778-9193
Mailing Address - Street 1:275 KINGSCLERE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-3033
Mailing Address - Country:US
Mailing Address - Phone:267-778-9193
Mailing Address - Fax:267-778-9194
Practice Address - Street 1:275 KINGSCLERE DR
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3033
Practice Address - Country:US
Practice Address - Phone:267-778-9193
Practice Address - Fax:267-778-9194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-17
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000004474332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies