OrganizationFairfield Family Practice PcFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address1300 Sheridan Street, Suite 1, Williamsport, PA 17701(570) 601-6202PECOS EnrollmentBased on the most recent information from CMS, provider Fairfield Family Practice Pc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1952409898Provider TypeOrganizationFull NameFairfield Family Practice PcSubpartNoEnumeration Date9/21/2006Last Updated8/22/2020Contact InformationPractice LocationPractice Address1300 Sheridan Street, Suite 1, Williamsport, PA 17701Phone(570) 601-6202Fax(570) 368-2064Mailing LocationMailing Address1300 Sheridan Street, Suite 1, Williamsport, PA 17701Phone(570) 601-6202Fax(570) 368-2064Authorized OfficialNamePellegrino, John A (Physician)Phone(570) 368-2002Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseDS008076LPennsylvaniaProvider IdentifiersIDDescriptionIssuerID0075301990002DescriptionMedicaidIssuerUnlistedPennsylvania