Basic Information
| Provider Information | |||||||||
| NPI: | 1942233879 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAIRFIELD ER PHYSICIANS DBA FAIRFIELD MEDICAL CENTER PRO FEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 713464 | ||||||||
| Address2: | FAIRFIELD MEDICAL CENTER PRO FEE BILLING | ||||||||
| City: | LANCASTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452713464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132814400 | ||||||||
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| Practice Location | |||||||||
| Address1: | FAIRFIELD EMERGENCY ROOM PHYSICIANS | ||||||||
| Address2: | 401 N EWING STREET | ||||||||
| City: | LANCASTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7406878100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 06/09/2011 | ||||||||
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| AuthorizedOfficialLastName: | DECOSTE | ||||||||
| AuthorizedOfficialFirstName: | MICHELE | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR/EMERGENCY ROOM | ||||||||
| AuthorizedOfficialTelephone: | 7406878101 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4939179 | 05 | OH | MEDICAID |