1164452371 NPI number — DAVID J. FOSCUE, M.D. PA

Table of content: (NPI 1164452371)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164452371 NPI number — DAVID J. FOSCUE, M.D. PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID J. FOSCUE, M.D. PA
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:
FOSCUE MEDICAL CLINIC
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:
1164452371
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
113 W CYPRESS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARREN
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71671-2730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-226-2844
Provider Business Mailing Address Fax Number:
870-226-5200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
113 W CYPRESS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71671-2730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-226-2844
Provider Business Practice Location Address Fax Number:
870-226-5200
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FOSCUE
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
870-226-2844

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  E0549 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1164452371 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 127969002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 127887001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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