Provider Demographics
NPI:1205958519
Name:FOUNDATION HEALTH CARE, INC
Entity type:Organization
Organization Name:FOUNDATION HEALTH CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:EVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-707-1425
Mailing Address - Street 1:6615 CLINGAN ROAD
Mailing Address - Street 2:SUITE D
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-4202
Mailing Address - Country:US
Mailing Address - Phone:330-707-1425
Mailing Address - Fax:330-757-2814
Practice Address - Street 1:821 MCCARTNEY RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-5000
Practice Address - Country:US
Practice Address - Phone:330-743-4440
Practice Address - Fax:330-743-4488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0928009Medicaid
OH0542578Medicaid
OH0542578Medicaid
OH9269101Medicare PIN
OH9371331Medicare PIN