Provider Demographics
NPI:1386604726
Name:FAIRFIELD MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:FAIRFIELD MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:J
Authorized Official - Middle Name:L
Authorized Official - Last Name:DOZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-712-0373
Mailing Address - Street 1:102 US HIGHWAY 321 BYP N
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29180-9251
Mailing Address - Country:US
Mailing Address - Phone:803-712-0373
Mailing Address - Fax:803-635-1760
Practice Address - Street 1:102 US HIGHWAY 321 BYP N
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:SC
Practice Address - Zip Code:29180-9251
Practice Address - Country:US
Practice Address - Phone:803-712-0373
Practice Address - Fax:803-635-1760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHTL154282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC197932Medicaid
SC400140Medicaid
SC376285Medicaid
SC400140Medicaid
SCCO1010Medicare ID - Type UnspecifiedRAILROAD MEDICARE
SC197932Medicaid
SC421302Medicare Oscar/Certification