Provider Demographics
NPI:1255373031
Name:FOUNDATION ANCILLARY SERVICES, LLC
Entity type:Organization
Organization Name:FOUNDATION ANCILLARY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICES
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-751-3685
Mailing Address - Street 1:17617 S HARRELLS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-3532
Mailing Address - Country:US
Mailing Address - Phone:225-751-3685
Mailing Address - Fax:225-753-0948
Practice Address - Street 1:17617 S HARRELLS FERRY RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-3532
Practice Address - Country:US
Practice Address - Phone:225-751-3685
Practice Address - Fax:225-753-0948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03632301Medicaid
PA1018334880001Medicaid
LA1454214Medicaid
MS03632301Medicaid