Basic Information
| Provider Information | |||||||||
| NPI: | 1528033297 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FAIRFIELD DEPARTMENT OF HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 550 | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431300550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7406875164 | ||||||||
| FaxNumber: | 7406541417 | ||||||||
| Practice Location | |||||||||
| Address1: | 1587 GRANVILLE PIKE | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7406534489 | ||||||||
| FaxNumber: | 7406896080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2006 | ||||||||
| LastUpdateDate: | 01/29/2008 | ||||||||
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| AuthorizedOfficialLastName: | HIRSCH | ||||||||
| AuthorizedOfficialFirstName: | FRANKLIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | HEALTH COMMISSIONER | ||||||||
| AuthorizedOfficialTelephone: | 7406534489 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 2323248 | 05 | OH | MEDICAID |