NPIMap

Organization Active NPI

Fairway Medical Center, LLC

  • General Acute Care Hospital
  • Covington, LA
National Provider Identifier
1851487086
Registry record updated Sep 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
FAIRWAY MEDICAL CENTER, LLC
Practice address
67252 Industry LN
Covington, LA 70433-8704
Phone
(985) 809-9888
Fax
(985) 801-3099
NPI assigned
Oct 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2022

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

Authorized official

Name
Mr. John William'Bill' Hankins
Title
Ceo
Phone
(985) 801-6246

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 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
O20041004000984 LA Part A Provider - Hospital 6406815687 Practice locations: Covington, LA; Hammond, LA

Hospital certification: CCN 190267

Legal name
FAIRWAY MEDICAL CENTER LLC
Doing business as
AVALA
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Feb 9, 2005
Last certification
Nov 17, 2023
Beds
21
Ownership / control type
Physician ownership
Organization structure
LLCProprietary
Incorporated
Aug 27, 1998 in LA
Enrollment address
67252 Industry LN
Covington, LA 70433-8704
Main/Primary Hospital Location
Hospital subgroups
Specialty hospital

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
AvalaCCN 190267
Type
Acute Care Hospitals
Ownership
Physician
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory
Tax ID family
Fairway Medical Center LLC2 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.

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Brooke Cummings Individual Operational/Managerial ControlCfo Oct 28, 2024
Fayez K Shamieh Individual Operational/Managerial ControlManager Feb 1, 2017
John W Hankins Individual Corporate OfficerCeo Aug 9, 2021
KSS Surgical, LLC Organization, Covington, LA LLC, For-profit 5% Or Greater Direct Ownership Interest Jun 1, 2018 66.51%
Khader S Shamieh Individual 5% Or Greater Indirect Ownership Interest Jun 1, 2018 67.41%
Operational/Managerial ControlManager Jun 1, 2018

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 103

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 103

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662595200000",
    "number": "1851487086",
    "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": "985-809-1588"
        },
        {
            "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": "2006-10-05",
        "last_updated": "2022-09-08",
        "certification_date": "2022-09-08",
        "status": "A",
        "authorized_official_last_name": "HANKINS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "WILLIAM'BILL'",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "985-801-6246",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avala",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Covington, LA

Sources for this page

Verify at the official NPI Registry.