Provider Demographics
| NPI: | 1609820539 |
|---|---|
| Name: | MEDICAL FOUNDATION, INC. |
| Entity Type: | Organization |
| Organization Name: | MEDICAL FOUNDATION, INC. |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | REGIONAL CEO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | DON |
| Authorized Official - Middle Name: | LARKIN |
| Authorized Official - Last Name: | KENNEDY |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 601-703-9614 |
| Mailing Address - Street 1: | DEPT 3020, PO BOX 1000 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | MEMPHIS |
| Mailing Address - State: | TN |
| Mailing Address - Zip Code: | 38148-3020 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 601-213-3010 |
| Mailing Address - Fax: | 601-213-3011 |
| Practice Address - Street 1: | 1314 19TH AVE |
| Practice Address - Street 2: | |
| Practice Address - City: | MERIDIAN |
| Practice Address - State: | MS |
| Practice Address - Zip Code: | 39301-4116 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 601-703-3310 |
| Practice Address - Fax: | 601-703-3311 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-05-22 |
| Last Update Date: | 2023-04-21 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
| No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
| No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
| No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty | |
| No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
| No | 363LA2100X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| MS | 09014742 | Medicaid | |
| MS | C02233 | Medicare PIN | |
| CE9490 | Medicare PIN | ||
| MS | C02315 | Medicare PIN | |
| MS | C01042 | Medicare PIN | |
| MS | 09014742 | Medicaid | |
| MS | C02390 | Medicare PIN | |
| MS | C02555 | Medicare PIN | |
| MS | C02314 | Medicare PIN | |
| CK0663 | Medicare PIN | ||
| MS | C02435 | Medicare PIN |
