Healthcare Provider Details

I. General information

NPI: 1295908853
Provider Name (Legal Business Name): FAIRFIELD MEMORIAL HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2008
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 NW 10TH ST SUITE A
FAIRFIELD IL
62837-1219
US

IV. Provider business mailing address

303 NW 11TH ST
FAIRFIELD IL
62837-1203
US

V. Phone/Fax

Practice location:
  • Phone: 618-842-4617
  • Fax: 618-842-4743
Mailing address:
  • Phone: 618-842-2611
  • Fax: 618-847-8323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MELODY MORGAN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 618-847-8260