Fairview Dermatology PLLC
Organization Active NPI Dermatology Physician · Fairview, TX
NPI 1073014114 · NPPES record last updated Nov 5, 2024
Key facts
- NPI
- 1073014114
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatology Physician 207N00000X
- Legal business name
- FAIRVIEW DERMATOLOGY PLLC
- Practice address
- 331 Town PL
Fairview, TX 75069-1825 - Phone
- (972) 747-0000
- Fax
- (972) 736-4020
- NPI assigned
- Feb 23, 2018
- Organization subpart
- No
Authorized official
- Name
- Andrew Hudson, MD
- Title
- Physician
- Phone
- (806) 570-5338
Practitioners 5
-
Helen Kim-James, M.D.
-
Michelle Kukielski, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D2173789 | Fairview Dermatology | Provider-performed microscopy | Oct 17, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180418000957 | TX | Part B Supplier - Clinic/Group Practice | 2264795673 |
Receives reassigned benefits from 5 practitioners Practice locations: Fairview, TX |
National Provider Directory
Locations
331 Town Pl
Fairview, TX 75069
Phone (972) 747-0000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician |
207N00000X | Yes |
Addresses
Primary practice location
331 Town PL
Fairview, TX 75069-1825
Mailing address
331 Town PL
Fairview, TX 75069-1825
Phone (972) 747-0000
Other providers in Fairview, TX
- Guijun Du
- Judy Eastburn
- Grace Cartwright Erturkuner
- Justine M Evans
- Harry Everett
- Fairview-Allen Orthodontics, PA
- Tina Feng
- Sophia Fluty
- Lauren Michelle Fox
- Allen Gandy
All providers in Fairview, TX · Dermatology Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 5, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.