Provider Demographics
NPI:1346500840
Name:FAIRFIELD MEDICAL CLINIC LLP
Entity Type:Organization
Organization Name:FAIRFIELD MEDICAL CLINIC LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CATRON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:406-467-2600
Mailing Address - Street 1:PO BOX 885
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:MT
Mailing Address - Zip Code:59436-0885
Mailing Address - Country:US
Mailing Address - Phone:406-467-2600
Mailing Address - Fax:406-467-3210
Practice Address - Street 1:223 W MAIN
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:MT
Practice Address - Zip Code:59436-0885
Practice Address - Country:US
Practice Address - Phone:406-467-2600
Practice Address - Fax:406-467-3210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT15597261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000037405OtherBCBS
MT0434486Medicaid
MT500002829OtherRAILROAD MEDICARE
MT000080319Medicare PIN
MTS32542Medicare UPIN