Provider Demographics
NPI:1427182294
Name:FAIRFIELD PRIMARY CARE, INC.
Entity Type:Organization
Organization Name:FAIRFIELD PRIMARY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SULEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-860-3016
Mailing Address - Street 1:2740 MACK RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5161
Mailing Address - Country:US
Mailing Address - Phone:513-860-3016
Mailing Address - Fax:513-860-3073
Practice Address - Street 1:2740 MACK RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5161
Practice Address - Country:US
Practice Address - Phone:513-860-3016
Practice Address - Fax:513-860-3073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCC4626OtherMEDICARE RAILROAD
OHFA9258621OtherMEDICARE