Healthcare Provider Details

I. General information

NPI: 1497061469
Provider Name (Legal Business Name): FOUNDATION MEDICAL STAFFING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 08/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 W 15TH ST STE 600
EDMOND OK
73013-3672
US

IV. Provider business mailing address

416 W 15TH ST STE 600
EDMOND OK
73013-3672
US

V. Phone/Fax

Practice location:
  • Phone: 800-774-9251
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number35725
License Number StateCA

VIII. Authorized Official

Name: MARK JACOBS
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 800-774-9251