Provider Demographics
NPI:1265635718
Name:FAIRFIELD COUNTY COMBINED GENERAL HEALTH DISTRICT
Entity Type:Organization
Organization Name:FAIRFIELD COUNTY COMBINED GENERAL HEALTH DISTRICT
Other - Org Name:FAIRFIELD DEPARTMENT OF HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:HEALTH COMMISSIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HIRSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MPH
Authorized Official - Phone:740-653-4489
Mailing Address - Street 1:1587 GRANVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-1038
Mailing Address - Country:US
Mailing Address - Phone:740-653-4489
Mailing Address - Fax:740-653-6626
Practice Address - Street 1:1155 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-4056
Practice Address - Country:US
Practice Address - Phone:740-689-6758
Practice Address - Fax:740-689-6759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058926251K00000X
OH261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2768429Medicaid
OH9375421Medicare PIN