FAIRMONT ENT ASSOCIATES INC. NPI 1659554046

NPI Information

  • NPI: 1659554046
  • Provider Name: FAIRMONT ENT ASSOCIATES, INC.
  • Classification: Clinic/Center - 261Q00000X
  • Entity Type: Organization
  • CLIA Number: 51D2179297
  • Address: 300 S PRICE ST
    KINGWOOD, WV
    ZIP 26537
  • Phone: (304) 366-6157

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NPI Details

FAIRMONT ENT ASSOCIATES, INC. is a clinic center in Kingwood, WV. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). FAIRMONT ENT ASSOCIATES, INC. NPI is 1659554046. The provider is registered as an organization entity type.

The provider's business location address is:

300 S PRICE ST
KINGWOOD, WV
ZIP 26537-442
Phone: (304) 366-6157
Fax: (304) 366-0177

The provider's authorized official is Joedy L Daristotle .
The authorized official title is Physician and has the following contact phone number (304) 366-6157.

The CLIA number assigned to this NPI record is 51D2179297 - other - non trans bls fd rapid re with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/10/2007 and was last updated on 5/22/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261Q00000XClinic/CenterWV14772WEST VIRGINIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1CL6325OTHERWEST VIRGINIARR MEDICARE
20041418000MEDICAIDWEST VIRGINIA
39181802MEDICARE PINWEST VIRGINIA
4E46210MEDICARE UPINWEST VIRGINIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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