MEDICARE: DR. HENRY FOOKS JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	35-08-7648	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00373066	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	000000439218	OTHER		ANTHEM BCBS
3	1356394415	OTHER		NPI
4	578765499	OTHER	OH	TRI CARE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	001870161	OTHER		MOUNTAIN STATE BCBS
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356394415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRY FOOKS JR. M.D.

Provider Business Mailing Address
First Line	:	90 JACKSON PIKE
Second Line	:
City	:	GALLIPOLIS
State	:	OH
Zip	:	45631-1560
Country	:	US
Telephone Number	:	740-446-5890
Fax Number	:	740-446-5532

Provider Business Practice Location Address
First Line	:	224 COLUMBUS RD
Second Line	:
City	:	ATHENS
State	:	OH
Zip	:	45701-1334
Country	:	US
Telephone Number	:	740-589-3100
Fax Number	:	740-589-3132

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	04/15/2022

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