Provider Demographics
NPI:1770231656
Name:MOREHEAD PEDIATRICS
Entity type:Organization
Organization Name:MOREHEAD PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:FOUCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-740-0986
Mailing Address - Street 1:130 NEWTOWNE SQ
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-2406
Mailing Address - Country:US
Mailing Address - Phone:606-740-0986
Mailing Address - Fax:606-780-9096
Practice Address - Street 1:130 NEWTOWNE SQ
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-2406
Practice Address - Country:US
Practice Address - Phone:606-740-0986
Practice Address - Fax:606-780-9096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-10
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty