Provider Demographics
NPI:1245435478
Name:LINDA A FOSTER MD
Entity type:Organization
Organization Name:LINDA A FOSTER MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALLERIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:COFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-815-0050
Mailing Address - Street 1:1589 SPARTA STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-1332
Mailing Address - Country:US
Mailing Address - Phone:931-815-0050
Mailing Address - Fax:931-815-0040
Practice Address - Street 1:1589 SPARTA ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1332
Practice Address - Country:US
Practice Address - Phone:931-815-0050
Practice Address - Fax:931-815-0040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD015823207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3156281OtherBLUE CROSS
TN3722033Medicaid
TN3156281OtherBLUE CROSS
TN3722033Medicaid