Provider Demographics
NPI:1366657272
Name:MARK H FOURNIER
Entity Type:Organization
Organization Name:MARK H FOURNIER
Other - Org Name:FOURNIER FOOT CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:FOURNIER
Authorized Official - Suffix:
Authorized Official - Credentials:CPED,OST
Authorized Official - Phone:413-586-6614
Mailing Address - Street 1:316 KING ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2333
Mailing Address - Country:US
Mailing Address - Phone:413-586-6614
Mailing Address - Fax:413-585-5729
Practice Address - Street 1:316 KING ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2333
Practice Address - Country:US
Practice Address - Phone:413-586-6614
Practice Address - Fax:413-585-5729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1308050001Medicare NSC