1174579791 NPI number — FAIRFIELD HEALTHCARE PROFESSIONALS, INC.

Table of content: (NPI 1174579791)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174579791 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:
Provider Other Organization Name Type Code:
6
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:
1174579791
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:
1153 E MAIN ST
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:
43130-4056
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-687-8990
Provider Business Mailing Address Fax Number:
740-687-8230

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1055 W MARKET ST
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43105-1283
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-862-4183
Provider Business Practice Location Address Fax Number:
740-862-3704
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PARRISH
Authorized Official First Name:
LORI
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
740-687-8343

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

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




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