Provider Demographics
NPI:1285711614
Name:MED-NET HEALTHCARE AFFILIATES, PC
Entity type:Organization
Organization Name:MED-NET HEALTHCARE AFFILIATES, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAX
Authorized Official - Middle Name:
Authorized Official - Last Name:FONER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-526-7695
Mailing Address - Street 1:361 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-2710
Mailing Address - Country:US
Mailing Address - Phone:901-526-7695
Mailing Address - Fax:901-525-4483
Practice Address - Street 1:361 N 3RD ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-2710
Practice Address - Country:US
Practice Address - Phone:901-526-7695
Practice Address - Fax:901-525-4483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2011-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3119555OtherMEDICARE INDIVIDUAL PTAN NUMBER FOR MAX FONER, M.D.
3389128OtherMEDICARE GROUP PTAN NUMBER
1649357062OtherMEDICARE INDIVIDUAL NPI NUMBER FOR MAX FONER, M.D.