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
State | License ID | Taxonomies |
---|---|---|
IL | 0000695 | 261QU0200X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QU0200X | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |