1346500840 NPI number — FAIRFIELD MEDICAL CLINIC LLP

Table of content: (NPI 1346500840)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346500840 NPI number — FAIRFIELD MEDICAL CLINIC LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAIRFIELD MEDICAL CLINIC LLP
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:
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:
1346500840
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 885
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59436-0885
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-467-2600
Provider Business Mailing Address Fax Number:
406-467-3210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
223 W MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59436-0885
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-467-2600
Provider Business Practice Location Address Fax Number:
406-467-3210
Provider Enumeration Date:
05/18/2012

Additional Information

Authorized Official

Authorized Official Last Name:
CATRON
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
406-467-2600

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  15597 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000037405 . This is a "BCBS" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 0434486 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 500002829 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com