Provider Demographics
NPI:1184737892
Name:FAIRFIELD MEDICAL ASSOCIATES, PA
Entity type:Organization
Organization Name:FAIRFIELD MEDICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-635-6461
Mailing Address - Street 1:P.O. BOX 1218
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29180-1280
Mailing Address - Country:US
Mailing Address - Phone:803-635-6461
Mailing Address - Fax:803-635-6089
Practice Address - Street 1:880 WEST MOULTRIE ST.
Practice Address - Street 2:SUITE 200
Practice Address - City:WINNSBORO
Practice Address - State:SC
Practice Address - Zip Code:29180-1280
Practice Address - Country:US
Practice Address - Phone:803-635-6487
Practice Address - Fax:803-635-6089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC207Q00000X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRHC002Medicaid
TN423840OtherBLUE CROSS BLUE SHIELD
SCPA3996Medicaid
SC5787Medicare PIN
SCRHC002Medicaid