1508978677 NPI number — ADENA FAYETTE MEDICAL CENTER

Table of content: (NPI 1508978677)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508978677 NPI number — ADENA FAYETTE MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADENA FAYETTE MEDICAL CENTER
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:
1508978677
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1450 COLUMBUS AVE
Provider Second Line Business Mailing Address:
SUITE B 6-7-8
Provider Business Mailing Address City Name:
WASHINGTON COURT HOUSE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43160-3701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-333-2236
Provider Business Mailing Address Fax Number:
740-333-3881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1430 COLUMBUS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON COURT HOUSE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43160-1703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-333-2705
Provider Business Practice Location Address Fax Number:
740-333-2998
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARLSON
Authorized Official First Name:
LISA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
740-779-7582

Provider Taxonomy Codes

  • Taxonomy code: 275N00000X , with the licence number:  1168 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , with the licence number: 1168 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0066355 . This is a "AETNA INSURANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 316008062044 . This is a "MEDICAL MUTUAL INSURANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000244918 . This is a "ANTHEM INSURANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0653982 . This is a "CIGNA INSURANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5020091 . This is a "UNITED HEALTHCARE INSURAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 316008062 . This is a "ALL OTHER PAYERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2675403 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34 . This is a "CENTRAL BENEFITS INSURANC" identifier . This identifiers is of the category "OTHER".




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