Provider Demographics
NPI:1538365523
Name:RICHARD F. FORD, MD, PSC
Entity type:Organization
Organization Name:RICHARD F. FORD, MD, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-324-2554
Mailing Address - Street 1:PO BOX 1327
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1327
Mailing Address - Country:US
Mailing Address - Phone:606-324-2554
Mailing Address - Fax:606-326-9368
Practice Address - Street 1:2245 WINCHESTER AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101
Practice Address - Country:US
Practice Address - Phone:606-324-2554
Practice Address - Fax:606-324-2551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31293174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64312937Medicaid
OH2138976Medicaid
0684901Medicare PIN
G94806Medicare UPIN
KY64312937Medicaid