1255372215 NPI number — FAIRFIELD HEALTHCARE PROFESSIONALS INC

Table of content: (NPI 1255372215)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255372215 NPI number — FAIRFIELD HEALTHCARE PROFESSIONALS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAIRFIELD HEALTHCARE PROFESSIONALS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FAIRFIELD PSYCHIATRIC SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255372215
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2563
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43130-5563
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-687-8499
Provider Business Mailing Address Fax Number:
740-687-8230

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
131 N EWING ST
Provider Second Line Business Practice Location Address:
UNIT C
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43130-3383
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-689-6600
Provider Business Practice Location Address Fax Number:
740-689-6603
Provider Enumeration Date:
06/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PARRISH
Authorized Official First Name:
LORI
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
740-687-8647

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CD3781 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0153462 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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