Provider Demographics
NPI:1871802306
Name:FOOS OB/GYN, P.C.
Entity type:Organization
Organization Name:FOOS OB/GYN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:COOKE
Authorized Official - Last Name:FOOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-724-3628
Mailing Address - Street 1:890 POPLAR CHURCH RD
Mailing Address - Street 2:SUITE 108, MEDICAL ARTS BUILDING
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-2250
Mailing Address - Country:US
Mailing Address - Phone:717-724-3628
Mailing Address - Fax:
Practice Address - Street 1:890 POPLAR CHURCH RD
Practice Address - Street 2:SUITE 108, MEDICAL ARTS BUILDING
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2250
Practice Address - Country:US
Practice Address - Phone:717-724-3628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065010L261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD065010LOtherMEDICAL LICENSE
MD065010LOtherMEDICAL LICENSE