NPIMap

Organization Active NPI

Fairway Medical Center, LLC

Doing business as Avala

  • Diagnostic Radiology Physician
  • Covington, LA
National Provider Identifier
1265023170
Registry record updated Jun 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
FAIRWAY MEDICAL CENTER, LLC
Doing business as
Avala
Practice address
67252 Industry LN
Covington, LA 70433-8704
Phone
(985) 809-9888
Fax
(985) 801-3099
NPI assigned
Feb 2, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lori Frey
Title
Director Revenue Cycle
Phone
(985) 801-6258

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

67252 Industry LN
Covington, LA 70433-8704

Mailing address

67252 Industry LN
Covington, LA 70433-8704
Phone (985) 809-9888

Other names 1

  • Avala Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210224001527 LA Part B Supplier - Hospital Department(S) 6406815687 Receives reassigned benefits from 18 practitioners
Practice locations: Covington, LA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Fairway Medical Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

7003 Highway 190 East Service Rd
Covington, LA 70433
Phone (985) 801-6265

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 26

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1612224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685577600000",
    "number": "1265023170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67252 INDUSTRY LN",
            "city": "COVINGTON",
            "state": "LA",
            "postal_code": "704338704",
            "telephone_number": "985-809-9888",
            "fax_number": "985-801-3099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67252 INDUSTRY LN",
            "city": "COVINGTON",
            "state": "LA",
            "postal_code": "704338704",
            "telephone_number": "985-809-9888",
            "fax_number": "985-801-3099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRWAY MEDICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-02",
        "last_updated": "2023-06-01",
        "certification_date": "2023-06-01",
        "status": "A",
        "authorized_official_last_name": "FREY",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "DIRECTOR REVENUE CYCLE",
        "authorized_official_telephone_number": "985-801-6258"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avala",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avala",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Covington, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.