Provider Demographics
NPI:1740358712
Name:FAIRFIELD COUNTY SCHOOLS
Entity type:Organization
Organization Name:FAIRFIELD COUNTY SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID SPECALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-635-4607
Mailing Address - Street 1:PO BOX 622
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29180-0622
Mailing Address - Country:US
Mailing Address - Phone:803-635-4607
Mailing Address - Fax:803-635-4825
Practice Address - Street 1:1226 U.S. HIGHWAY 321 BY PASS SOUTH
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:SC
Practice Address - Zip Code:29180-0622
Practice Address - Country:US
Practice Address - Phone:803-635-4607
Practice Address - Fax:803-635-4825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)