Provider Demographics
NPI:1891766382
Name:FAIRFIELD OB/GYN ASSOC INC
Entity Type:Organization
Organization Name:FAIRFIELD OB/GYN ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:NOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-451-7346
Mailing Address - Street 1:PO BOX 20451
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220
Mailing Address - Country:US
Mailing Address - Phone:614-451-7346
Mailing Address - Fax:614-451-5846
Practice Address - Street 1:1319 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:43130
Practice Address - Country:US
Practice Address - Phone:614-451-7346
Practice Address - Fax:614-451-5846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004690G207V00000X
OH34004960G261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0148450Medicaid
OHGU0634263Medicare ID - Type Unspecified
OH0148450Medicaid