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General NPI Number Information
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NPI Number | 1508978677
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Entity Type | Organization
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Legal Business Name | ADENA FAYETTE MEDICAL CENTER
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 06/02/2021
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Provider Practice Location Address
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Address Line | 1430 COLUMBUS AVE
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City | WASHINGTON COURT HOUSE
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State | OH
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Zip | 43160-1703
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Country | US
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Telephone | 740-333-2705
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Fax | 740-333-2998
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Provider Business Mailing Address
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Address Line | 1450 COLUMBUS AVE SUITE B 6-7-8
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City | WASHINGTON COURT HOUSE
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State | OH
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Zip | 43160-3701
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Country | US
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Telephone | 740-333-2236
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Fax | 740-333-3881
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Authorized Official
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Title or Position | CFO
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Name | LISA M CARLSON
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Credential |
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Telephone | 740-779-7582
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 275N00000X
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Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
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License Number | 1168
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 1168
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License Number State | OH
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