Organization
FOUNDATION INTERNAL MEDICINE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH OSITA EDMUNDS MD (MEDICAL DIRECTOR/PRESIDENT)
(662) 349-9292
Entity
Organization
Contact information
Practice address
401 SOUTHCREST CIR, SUITE 207, SOUTHAVEN, MS 38671-6726
(662) 349-9292
(662) 349-8603
Mailing address
401 SOUTHCREST CIR, SUITE 207, SOUTHAVEN, MS 38671-6726
(662) 349-9292
(662) 349-8603
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
14060
MS
261QP2300X
Primary Care Clinic/Center
Primary
14060
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015617
—
MS
Enumeration date
07/22/2007
Last updated
07/22/2007
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