1942268651 NPI number — FOUNDATION HEALTH SYSTEMS CORP

Table of content: (NPI 1437310893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942268651 NPI number — FOUNDATION HEALTH SYSTEMS CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOUNDATION HEALTH SYSTEMS CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
EDWIN H. MARTINAT COMPREHENSIVE OUTPATIENT REHABILITATION CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942268651
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 FRONTIS PLAZA BLVD STE 200
Provider Second Line Business Mailing Address:
(ATTN) FORSYTH MEDICAL GROUP
Provider Business Mailing Address City Name:
WINSTON SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27103-5616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-277-2435
Provider Business Mailing Address Fax Number:
336-277-9275

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
865 W LAKE DR
Provider Second Line Business Practice Location Address:
DBA EDWIN H. MARTINAT
Provider Business Practice Location Address City Name:
MOUNT AIRY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27030-2157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-719-6165
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LINER
Authorized Official First Name:
SALLYE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXE.VP & CCO & ADMIN
Authorized Official Telephone Number:
336-718-2004

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





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