Foundation Internal Medicine, P.C.

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

14060 Issued in MS

Legal business name

FOUNDATION INTERNAL MEDICINE, P.C.

Practice address

401 Southcrest Cir
Suite 207
Southaven, MS 38671-6726

Phone

(662) 349-9292

Fax

(662) 349-8603

NPI assigned

Jul 22, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kenneth Osita Edmunds, MD

Title

Medical Director/President

Phone

(662) 349-9292

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1185062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185062400000",
    "number": "1255531885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 SOUTHCREST CIR",
            "address_2": "SUITE 207",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386716726",
            "telephone_number": "662-349-9292",
            "fax_number": "662-349-8603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 SOUTHCREST CIR",
            "address_2": "SUITE 207",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386716726",
            "telephone_number": "662-349-9292",
            "fax_number": "662-349-8603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNDATION INTERNAL MEDICINE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-22",
        "last_updated": "2007-07-22",
        "status": "A",
        "authorized_official_last_name": "EDMUNDS",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "OSITA",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR/PRESIDENT",
        "authorized_official_telephone_number": "662-349-9292",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "MS",
            "license": "14060",
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MS",
            "license": "14060",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09015617",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristin Schick Fonseca, O.D.
• Christy Fontenot, L.C.S.W.
• Nicole Marie Fontenot, DO
• Daniel B Fore, M.D.
• James Everett Fortune, M.D.
• Denise F Fowler, LCSW
• Levi Fowler, DPT
• Mary Ashton Fowler, P-LPC
• Mary Fox
• Jennifer B Fredrickson, APN

• Primary Care Clinic/Center in Southaven, MS
• Providers in Southaven, MS by specialty
• Primary Care Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.