Healthcare Provider Details

I. General information

NPI: 1770594277
Provider Name (Legal Business Name): FAIRFIELD MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 NW 11TH ST
FAIRFIELD IL
62837-1203
US

IV. Provider business mailing address

303 NW 11TH ST
FAIRFIELD IL
62837-1203
US

V. Phone/Fax

Practice location:
  • Phone: 618-842-2611
  • Fax: 618-847-8370
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: STEPHEN DAWKINS
Title or Position: DIR OF PHARMACY OPS
Credential:
Phone: 618-842-2611