Healthcare Provider Details

I. General information

NPI: 1306076427
Provider Name (Legal Business Name): MEDICAL FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 19TH AVE
MERIDIAN MS
39301-4116
US

IV. Provider business mailing address

PO BOX 5183
MERIDIAN MS
39302-5183
US

V. Phone/Fax

Practice location:
  • Phone: 601-703-4282
  • Fax: 601-703-3080
Mailing address:
  • Phone: 601-703-9393
  • Fax: 601-703-3080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DON LARKIN KENNEDY
Title or Position: PRESIDENT
Credential:
Phone: 601-703-9614