=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073748604
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS W FOSTER MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2009
-----------------------------------------------------
Last Update Date | 03/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 624 HOSPITAL DR
-----------------------------------------------------
City | MOUNTAIN HOME
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72653-2955
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-508-6400
-----------------------------------------------------
Fax | 870-424-1609
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 624 HOSPITAL DR
-----------------------------------------------------
City | MOUNTAIN HOME
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72653-2955
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-508-6400
-----------------------------------------------------
Fax | 870-424-1609
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0805X
-----------------------------------------------------
Taxonomy Name | Geriatric Psychiatry Physician
-----------------------------------------------------
License Number | MD14314
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | E8678
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------