Provider Demographics
NPI:1306882782
Name:FORD, SIMPSON, LIVELY & RICE PEDIATRICS
Entity type:Organization
Organization Name:FORD, SIMPSON, LIVELY & RICE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF RISK MANAGEMENT OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:W
Authorized Official - Last Name:CAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-802-2406
Mailing Address - Street 1:2909 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4009
Mailing Address - Country:US
Mailing Address - Phone:336-794-3380
Mailing Address - Fax:336-794-3378
Practice Address - Street 1:2909 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4009
Practice Address - Country:US
Practice Address - Phone:336-794-3380
Practice Address - Fax:336-794-3378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901759Medicaid
NCCC4243OtherRR MEDICARE
NC5905488Medicaid
NCCB8658OtherRR MEDICARE
NCCF9200OtherRR MEDICARE
NCCC5472OtherRR MEDICARE
NCCD6614OtherRR MEDICARE
NC89015U1Medicaid
NC020E1OtherBCBS GROUP
NC5909124Medicaid
NCCC4241OtherRR MEDICARE
NCCC4242OtherRR MEDICARE
NCCC6608OtherRR MEDICARE