Provider Demographics
NPI:1255422416
Name:FAIRFIELD MEMORIAL HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:FAIRFIELD MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-847-8260
Mailing Address - Street 1:303 NW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62837-1203
Mailing Address - Country:US
Mailing Address - Phone:618-847-8260
Mailing Address - Fax:618-847-8387
Practice Address - Street 1:303 NW 11TH ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IL
Practice Address - Zip Code:62837-1203
Practice Address - Country:US
Practice Address - Phone:618-847-8260
Practice Address - Fax:618-847-8387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0000679282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL246954OtherHEALTHLINK
IL0198OtherBCBS HOSP
IL09615287OtherBCBS ANES
IL102912OtherHEALTHLINK
IL182766OtherHEALTHLINK
IL09615280OtherBCBS MD ER
IL246954OtherHEALTHLINK
IL09615287OtherBCBS ANES
IL=========401Medicaid
IL584290Medicare ID - Type UnspecifiedMEDICARE ANES
IL141311Medicare ID - Type UnspecifiedMEDICARE
IL246954OtherHEALTHLINK