NPIMap

Organization Active NPI

Fayette Memorial Hospital Assoc

  • Urgent Care Clinic/Center
  • Liberty, IN
National Provider Identifier
1225007982
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
License
OS0050591 Issued in IN
Legal business name
FAYETTE MEMORIAL HOSPITAL ASSOC
Practice address
950 Market St
Liberty, IN 47353
Phone
(765) 458-5191
NPI assigned
Mar 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Marilyn M Thompson
Title
Controller Avp
Phone
(765) 827-7709

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X OS0050591 IN Primary

Addresses

Primary practice location

950 Market St
Liberty, IN 47353

Mailing address

1941 Virginia Ave
Connersville, IN 47331
Phone (765) 827-7762

Other identifiers 1

IdentifierTypeStateIssuer
2320358MedicaidOH

Other names 1

  • Union County Immediate Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Fayette Memorial Hospital Association Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1225007982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1941 VIRGINIA AVE",
            "city": "CONNERSVILLE",
            "state": "IN",
            "postal_code": "47331",
            "telephone_number": "765-827-7762",
            "fax_number": "765-827-7796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 MARKET ST",
            "city": "LIBERTY",
            "state": "IN",
            "postal_code": "47353",
            "telephone_number": "765-458-5191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTE MEMORIAL HOSPITAL ASSOC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "MARILYN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CONTROLLER AVP",
        "authorized_official_telephone_number": "765-827-7709",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "IN",
            "license": "OS0050591",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2320358",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Union County Immediate Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Liberty, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.