Provider Demographics
NPI:1932523867
Name:FOREMAN, JAMES (BHRS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:FOREMAN
Suffix:
Gender:M
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74467-5221
Mailing Address - Country:US
Mailing Address - Phone:918-485-1573
Mailing Address - Fax:
Practice Address - Street 1:118 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467-5221
Practice Address - Country:US
Practice Address - Phone:918-485-1573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)