1093050957 NPI number — MR. KENNETH A. FOLSOM HAS, BC-HIS, ACA

Table of content: MR. KENNETH A. FOLSOM HAS, BC-HIS, ACA (NPI 1093050957)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093050957 NPI number — MR. KENNETH A. FOLSOM HAS, BC-HIS, ACA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOLSOM
Provider First Name:
KENNETH
Provider Middle Name:
A.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
HAS, BC-HIS, ACA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1093050957
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
903 N. MONROE ST.
Provider Second Line Business Mailing Address:
#3
Provider Business Mailing Address City Name:
TALLAHASSEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-898-5633
Provider Business Mailing Address Fax Number:
850-898-4994

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
903 N MONROE ST
Provider Second Line Business Practice Location Address:
#3
Provider Business Practice Location Address City Name:
TALLAHASSEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-878-5633
Provider Business Practice Location Address Fax Number:
850-878-4994
Provider Enumeration Date:
12/04/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 237700000X , with the licence number:  AS972 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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