=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881403426
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAIRFIELD COMMUNITY HEALTH CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2025
-----------------------------------------------------
Last Update Date | 08/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 220 E WALNUT ST
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43130-4464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-277-6043
-----------------------------------------------------
Fax | 740-901-9506
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 220 E WALNUT ST
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43130-4464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-452-7685
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF COMPLIANCE OFFICER
-----------------------------------------------------
Name | ERIC B. BLAKE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 740-452-7685
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------