MEDICARE: FOUNDATION MEDICAL STAFFING

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	314000000X	Skilled Nursing Facility	56007952	LA

General Provider Information

NPI Number	:	1770792533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNDATION MEDICAL STAFFING

Provider Business Mailing Address
First Line	:	416 W. 15TH BULIDING 700
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013
Country	:	US
Telephone Number	:	405-285-2868
Fax Number	:	405-285-0367

Provider Business Practice Location Address
First Line	:	416 W 15TH ST
Second Line	:	BUILDING 700
City	:	EDMOND
State	:	OK
Zip	:	73013-3747
Country	:	US
Telephone Number	:	405-285-2868
Fax Number	:	405-285-0367

Authorized Official
Title or Position	:	TRAVELING OCCUPATIONAL THERAPIST
Name	:	ALLISON GONZALEZ
Credential	:	OT
Telephone Number	:	504-481-9800

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	08/22/2020

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