Provider Demographics
NPI:1083703532
Name:FAIRFIELD MEDICAL CENTER INC
Entity Type:Organization
Organization Name:FAIRFIELD MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NABIL
Authorized Official - Middle Name:F
Authorized Official - Last Name:ATHANASSIOUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-425-3888
Mailing Address - Street 1:1930 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533
Mailing Address - Country:US
Mailing Address - Phone:707-425-3888
Mailing Address - Fax:707-425-7757
Practice Address - Street 1:1930 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533
Practice Address - Country:US
Practice Address - Phone:707-425-3888
Practice Address - Fax:707-425-7757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA409530208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA29256Medicare UPIN
CA18775276613Medicare ID - Type Unspecified