Provider Demographics
NPI:1396838199
Name:FOLEY WALK-IN MED CARE
Entity Type:Organization
Organization Name:FOLEY WALK-IN MED CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AWADHESH
Authorized Official - Middle Name:K
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-970-3400
Mailing Address - Street 1:1440 N MCKENZIE ST
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-2234
Mailing Address - Country:US
Mailing Address - Phone:251-970-3400
Mailing Address - Fax:251-970-3406
Practice Address - Street 1:1440 N MCKENZIE ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2234
Practice Address - Country:US
Practice Address - Phone:251-970-3400
Practice Address - Fax:251-970-3406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529901230Medicaid
AL51008296OtherBLUE CROSS BLUE SHIELD