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General NPI Number Information
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NPI Number | 1104760685
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Entity Type | Organization
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Legal Business Name | FOUNDATION MEDICAL LLC
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Dates
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Enumeration Date | 04/16/2026
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Last Update Date | 04/16/2026
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Provider Practice Location Address
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Address Line | 456 E STATE RD STE 1400
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City | AMERICAN FORK
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State | UT
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Zip | 84003-2609
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Country | US
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Telephone | 804-506-0526
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Fax |
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Provider Business Mailing Address
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Address Line | 11600 BUSY STREET STE 203
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City | RICHMOND
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State | VA
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Zip | 23236-4066
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Country | US
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Telephone | 804-506-0526
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Fax | 804-506-0526
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Authorized Official
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Title or Position | CEO
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Name | TIMOTHY JAMES BUNTON
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Credential |
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Telephone | 804-506-0526
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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