Healthcare Provider Details

I. General information

NPI: 1023381050
Provider Name (Legal Business Name): SAMUEL FOOSE FORD H.I.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2012
Last Update Date: 02/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3491 BLUECUTT RD STE 7
COLUMBUS MS
39705-1343
US

IV. Provider business mailing address

3491 BLUECUTT RD STE 7
COLUMBUS MS
39705-1343
US

V. Phone/Fax

Practice location:
  • Phone: 662-327-3422
  • Fax: 662-327-3421
Mailing address:
  • Phone: 662-327-3422
  • Fax: 662-327-3421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA0560
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: