Healthcare Provider Details

I. General information

NPI: 1538496575
Provider Name (Legal Business Name): FIELDS MINI-MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2009
Last Update Date: 11/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 S MAIN ST
WAYNESVILLE OH
45068-9553
US

IV. Provider business mailing address

415 S MAIN ST
WAYNESVILLE OH
45068-9553
US

V. Phone/Fax

Practice location:
  • Phone: 513-897-7076
  • Fax: 513-897-1446
Mailing address:
  • Phone: 513-897-7076
  • Fax: 513-897-1446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KATHERINE VAUGHN FIELDS
Title or Position: CLINICAL PHARMACIST
Credential: PHARMD
Phone: 513-897-7076