Glenn Albert Fairall
Technician/Technologist in Albany, OR. Individual provider (NPI-1).
NPI number1982169611
StatusActive
Last updated in NPPESFeb 6, 2019
Details
- NPI
- 1982169611
- Entity type
- Individual (NPI-1)
- Name
- Glenn Albert Fairall
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Feb 6, 2019
- Last updated
- Feb 6, 2019
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 156F00000X | Technician/Technologist | 88193 | OR | Yes |
Practice location
2532 Nw Ashley DrAlbany, OR 97321-1395
Phone 541-979-1019
Mailing address
Po Box 741Albany, OR 97321-0252
Phone 541-979-1019
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