Provider Demographics
NPI:1679302228
Name:FAIRWAY MEDICAL LLC
Entity type:Organization
Organization Name:FAIRWAY MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:EHRFURTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-518-7319
Mailing Address - Street 1:W175N11081 STONEWOOD DR STE 106
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-4771
Mailing Address - Country:US
Mailing Address - Phone:262-518-7319
Mailing Address - Fax:262-450-4056
Practice Address - Street 1:W175N11081 STONEWOOD DR STE 106
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-4771
Practice Address - Country:US
Practice Address - Phone:262-518-7319
Practice Address - Fax:262-450-4056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-31
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies