Provider Demographics
NPI:1558308700
Name:FOSTER, JAMES M (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:M
Last Name:FOSTER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
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Mailing Address - Street 1:1 SEAGATE
Mailing Address - Street 2:STE 800
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:270-684-5005
Mailing Address - Fax:270-926-4432
Practice Address - Street 1:815 E PARRISH AVE
Practice Address - Street 2:SUITE 460
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-3222
Practice Address - Country:US
Practice Address - Phone:270-684-5005
Practice Address - Fax:270-926-4432
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY606A367500000X
OH05286367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY74060617Medicaid
KY74060617Medicaid