Healthcare Provider Details

I. General information

NPI: 1558418111
Provider Name (Legal Business Name): FAIRFIELD MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
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: 618-847-8244
  • Fax:
Mailing address:
  • Phone: 618-847-8346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number1479915
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number1471476
License Number StateIL

VIII. Authorized Official

Name: MARY KNIGHT
Title or Position: STAFF ACCOUNTANT
Credential:
Phone: 618-847-8346