Healthcare Provider Details

I. General information

NPI: 1487702973
Provider Name (Legal Business Name): FAIRFIELD MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 US HWY 321 BYPASS N
WINNSBORO SC
29180
US

IV. Provider business mailing address

102 US HWY 321 BYPASS N
WINNSBORO SC
29180
US

V. Phone/Fax

Practice location:
  • Phone: 803-712-0373
  • Fax: 803-635-1760
Mailing address:
  • Phone: 803-712-0373
  • Fax: 803-635-1760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License NumberHTL154
License Number StateSC

VIII. Authorized Official

Name: MR. J L DOZIER
Title or Position: CEO
Credential:
Phone: 803-712-0373