Provider Demographics
NPI:1679049050
Name:FAIRFIELD HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:FAIRFIELD HOSPITAL DISTRICT
Other - Org Name:FREESTONE HEALTH CLINIC AT TEAGUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:YEARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-389-2121
Mailing Address - Street 1:734 W COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:75840-1428
Mailing Address - Country:US
Mailing Address - Phone:903-389-2181
Mailing Address - Fax:903-389-0906
Practice Address - Street 1:604 MAIN ST
Practice Address - Street 2:
Practice Address - City:TEAGUE
Practice Address - State:TX
Practice Address - Zip Code:75860-1628
Practice Address - Country:US
Practice Address - Phone:903-389-2181
Practice Address - Fax:903-389-0906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-23
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty