Provider Demographics
NPI:1093730681
Name:FAIRFIELD HEALTHCARE PROFESSIONALS INC
Entity Type:Organization
Organization Name:FAIRFIELD HEALTHCARE PROFESSIONALS INC
Other - Org Name:SOUTHEASTERN SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:PARRISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-687-8499
Mailing Address - Street 1:PO BOX 2563
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-5563
Mailing Address - Country:US
Mailing Address - Phone:740-687-8499
Mailing Address - Fax:740-687-8230
Practice Address - Street 1:214 HARMON AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3361
Practice Address - Country:US
Practice Address - Phone:740-689-9803
Practice Address - Fax:740-689-9808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCD3781OtherMEDICARE RAILROAD
OH0153462Medicaid
OH0153462Medicaid