Provider Demographics
NPI:1942233879
Name:FAIRFIELD ER PHYSICIANS DBA FAIRFIELD MEDICAL CENTER PRO FEE
Entity Type:Organization
Organization Name:FAIRFIELD ER PHYSICIANS DBA FAIRFIELD MEDICAL CENTER PRO FEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/EMERGENCY ROOM
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:DECOSTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-687-8101
Mailing Address - Street 1:P.O. BOX 713464
Mailing Address - Street 2:FAIRFIELD MEDICAL CENTER PRO FEE BILLING
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:45271-3464
Mailing Address - Country:US
Mailing Address - Phone:513-281-4400
Mailing Address - Fax:
Practice Address - Street 1:FAIRFIELD EMERGENCY ROOM PHYSICIANS
Practice Address - Street 2:401 N EWING STREET
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130
Practice Address - Country:US
Practice Address - Phone:740-687-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4939179Medicaid
OH=========OtherTAX ID NUMBER
OH4939179Medicaid