Provider Demographics
NPI:1538496575
Name:FIELDS MINI-MEDICAL CLINIC
Entity Type:Organization
Organization Name:FIELDS MINI-MEDICAL CLINIC
Other - Org Name:FIELDS FAMILY ENTERPRISES
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:VAUGHN
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:513-897-7076
Mailing Address - Street 1:415 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45068-9553
Mailing Address - Country:US
Mailing Address - Phone:513-897-7076
Mailing Address - Fax:513-897-1446
Practice Address - Street 1:415 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:OH
Practice Address - Zip Code:45068-9553
Practice Address - Country:US
Practice Address - Phone:513-897-7076
Practice Address - Fax:513-897-1446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center