Provider Demographics
NPI:1083828974
Name:FOUNDATION HEALTH CARE INC.
Entity Type:Organization
Organization Name:FOUNDATION HEALTH CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:EVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-707-1425
Mailing Address - Street 1:6615 CLINGAN ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514
Mailing Address - Country:US
Mailing Address - Phone:330-707-1425
Mailing Address - Fax:330-757-2814
Practice Address - Street 1:6615 CLINGAN ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514
Practice Address - Country:US
Practice Address - Phone:330-707-1425
Practice Address - Fax:330-757-2814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-049373207Q00000X
OH35-04-7881207Q00000X
OH34-00-5052207R00000X
OH35-08-6492207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1073597472OtherNPI
1467436261OtherNPI
OHFO9371331OtherPTAN
1588630404OtherNPI
1952385965OtherNPI
1588630404OtherNPI
1952385965OtherNPI
OHMO4167082Medicare PIN
OHMA0856935Medicare PIN
1467436261OtherNPI
OHD89577Medicare UPIN
OHFRO546151Medicare PIN
OH9371331Medicare PIN
OHFO9371331OtherPTAN
OHA15664Medicare UPIN
OHFR0546152Medicare PIN