Provider Demographics
NPI:1144642794
Name:FEMM FOUNDATION
Entity type:Organization
Organization Name:FEMM FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FEMM CLINICAL CARE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSTARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-360-9995
Mailing Address - Street 1:PO BOX 16914
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4064
Mailing Address - Country:US
Mailing Address - Phone:614-360-9995
Mailing Address - Fax:614-745-0165
Practice Address - Street 1:400 ALTAIR PKWY STE 3100
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7624
Practice Address - Country:US
Practice Address - Phone:614-360-9995
Practice Address - Fax:614-745-0165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-16
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1184864431Medicaid
OH1851969166Medicaid
MI1306892054Medicaid
MI1033304092Medicaid
OH1730623067Medicaid