Provider Demographics
NPI:1821655432
Name:FOUNDATION MEDICAL CENTER
Entity Type:Organization
Organization Name:FOUNDATION MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:MASSENBURG
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:804-301-5242
Mailing Address - Street 1:300A TEMPLE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-2972
Mailing Address - Country:US
Mailing Address - Phone:804-301-5242
Mailing Address - Fax:
Practice Address - Street 1:300A TEMPLE LAKE DR
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2972
Practice Address - Country:US
Practice Address - Phone:804-301-5242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-20
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center