Provider Demographics
NPI:1255522967
Name:CHARLES H. FOHN M.D.P.A.
Entity type:Organization
Organization Name:CHARLES H. FOHN M.D.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:FOHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-836-5013
Mailing Address - Street 1:415 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71701-4615
Mailing Address - Country:US
Mailing Address - Phone:870-836-5013
Mailing Address - Fax:
Practice Address - Street 1:415 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-4615
Practice Address - Country:US
Practice Address - Phone:870-836-5013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2009-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR103652002Medicaid
51730OtherBCBS
AR103616001Medicaid
AR770160901Medicaid
AR022704754OtherPALMETTO GBA
AR13280000000OtherQUAL CHOICE
AR103616001Medicaid
AR022704754OtherPALMETTO GBA