Provider Demographics
NPI:1497540314
Name:FOUNDATION MEDICAL GROUP
Entity type:Organization
Organization Name:FOUNDATION MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KRIDER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:629-223-5392
Mailing Address - Street 1:1311 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-3300
Mailing Address - Country:US
Mailing Address - Phone:629-223-5392
Mailing Address - Fax:615-599-6988
Practice Address - Street 1:308 HARPETH HILLS DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37069-6205
Practice Address - Country:US
Practice Address - Phone:858-776-3538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-11
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty