Provider Demographics
NPI:1700917994
Name:MEDICAL FOUNDATION, INC.
Entity Type:Organization
Organization Name:MEDICAL FOUNDATION, INC.
Other - Org Name:OCHSNER RUSH MEDICAL CENTER EMERGENCY ROOM PROFESSIONAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL CEO
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:LARKIN
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-703-9614
Mailing Address - Street 1:DEPT 3020, P.O. BOX 1000
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-3020
Mailing Address - Country:US
Mailing Address - Phone:601-213-3010
Mailing Address - Fax:601-213-3011
Practice Address - Street 1:1314 19TH AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4116
Practice Address - Country:US
Practice Address - Phone:601-703-9260
Practice Address - Fax:601-703-4050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529702610Medicaid
MS09014812Medicaid