Basic Information
| Provider Information | |||||||||
| NPI: | 1356394415 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOOKS | ||||||||
| FirstName: | HENRY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 90 JACKSON PIKE | ||||||||
| Address2: | |||||||||
| City: | GALLIPOLIS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456311560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404465890 | ||||||||
| FaxNumber: | 7404465532 | ||||||||
| Practice Location | |||||||||
| Address1: | 224 COLUMBUS RD | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457011334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405893100 | ||||||||
| FaxNumber: | 7405893132 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 04/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 04/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 35-08-7648 | OH | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | P00373066 | 01 | RR MEDICARE | OTHER | 000000439218 | 01 | ANTHEM BCBS | OTHER | 1356394415 | 01 | NPI | OTHER | 578765499 | 01 | OH | TRI CARE | OTHER | 2662622 | 05 | OH | MEDICAID | 001870161 | 01 | MOUNTAIN STATE BCBS | OTHER | 3810005680 | 05 | WV | MEDICAID |