Provider Demographics
NPI:1174175137
Name:FOSTER, RUDY MCCOY
Entity type:Individual
Prefix:
First Name:RUDY
Middle Name:MCCOY
Last Name:FOSTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5765 ALLISON RD
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27311-9038
Mailing Address - Country:US
Mailing Address - Phone:336-694-4830
Mailing Address - Fax:336-694-4830
Practice Address - Street 1:5765 ALLISON RD
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NC
Practice Address - Zip Code:27311-9038
Practice Address - Country:US
Practice Address - Phone:336-694-4830
Practice Address - Fax:336-694-4830
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
347C00000X
NC343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle