MEDICARE: FOUNDATION HEALTH SYSTEMS CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1730716267
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNDATION HEALTH SYSTEMS CORP

Provider Business Mailing Address
First Line	:	PO BOX 751803
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1803
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7210 VILLAGE MEDICAL CIR STE 115
Second Line	:
City	:	CLEMMONS
State	:	NC
Zip	:	27012-8029
Country	:	US
Telephone Number	:	336-893-2460
Fax Number	:

Authorized Official
Title or Position	:	ENROLLMENT MANAGER
Name	:	SHALA DAVIS
Credential	:
Telephone Number	:	704-316-7845

Provider Enumeration Date	:	03/25/2020
Last Update Date	:	03/25/2020

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Directions to “FOUNDATION HEALTH SYSTEMS CORP ” Practice Location

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