Provider Demographics
NPI:1790146728
Name:FAYETTE COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:FAYETTE COUNTY HOSPITAL DISTRICT
Other - Org Name:FCH EXPRESS CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:STARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-283-5401
Mailing Address - Street 1:650 W TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62471-1227
Mailing Address - Country:US
Mailing Address - Phone:618-283-1231
Mailing Address - Fax:
Practice Address - Street 1:825 NEW YORK DR
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:IL
Practice Address - Zip Code:62471-1044
Practice Address - Country:US
Practice Address - Phone:618-283-5545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0000695261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care