Provider Demographics
NPI:1215029301
Name:KNOX GYNECOLOGICAL SPECIALISTS
Entity Type:Organization
Organization Name:KNOX GYNECOLOGICAL SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:FAIRCHILD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-397-2155
Mailing Address - Street 1:1320 COSHOCTON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-6400
Mailing Address - Country:US
Mailing Address - Phone:740-397-2155
Mailing Address - Fax:740-397-6404
Practice Address - Street 1:1320 COSHOCTON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-6400
Practice Address - Country:US
Practice Address - Phone:740-397-2155
Practice Address - Fax:740-397-6404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0542934Medicaid
OHKN9918222Medicare ID - Type Unspecified