Provider Demographics
NPI:1508978677
Name:ADENA FAYETTE MEDICAL CENTER
Entity Type:Organization
Organization Name:ADENA FAYETTE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-779-7582
Mailing Address - Street 1:1450 COLUMBUS AVE
Mailing Address - Street 2:SUITE B 6-7-8
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160-3701
Mailing Address - Country:US
Mailing Address - Phone:740-333-2236
Mailing Address - Fax:740-333-3881
Practice Address - Street 1:1430 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-1703
Practice Address - Country:US
Practice Address - Phone:740-333-2705
Practice Address - Fax:740-333-2998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1168275N00000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
0066355OtherAETNA INSURANCE
316008062044OtherMEDICAL MUTUAL INSURANCE
000000244918OtherANTHEM INSURANCE
0653982OtherCIGNA INSURANCE
5020091OtherUNITED HEALTHCARE INSURAN
316008062OtherALL OTHER PAYERS
OH2675403Medicaid
34OtherCENTRAL BENEFITS INSURANC
OH2675403Medicaid