Basic Information
| Provider Information | |||||||||
| NPI: | 1306882782 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FORD, SIMPSON, LIVELY & RICE PEDIATRICS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2909 MAPLEWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271034009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367943380 | ||||||||
| FaxNumber: | 3367943378 | ||||||||
| Practice Location | |||||||||
| Address1: | 2909 MAPLEWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271034009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367943380 | ||||||||
| FaxNumber: | 3367943378 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 05/13/2009 | ||||||||
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| AuthorizedOfficialLastName: | CAGLE | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | CHEIF RISK MANAGEMENT OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3368022406 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 8901759 | 05 | NC | MEDICAID | CC4243 | 01 | NC | RR MEDICARE | OTHER | 5905488 | 05 | NC | MEDICAID | CB8658 | 01 | NC | RR MEDICARE | OTHER | CF9200 | 01 | NC | RR MEDICARE | OTHER | CC5472 | 01 | NC | RR MEDICARE | OTHER | CD6614 | 01 | NC | RR MEDICARE | OTHER | 89015U1 | 05 | NC | MEDICAID | 020E1 | 01 | NC | BCBS GROUP | OTHER | 5909124 | 05 | NC | MEDICAID | CC4241 | 01 | NC | RR MEDICARE | OTHER | CC4242 | 01 | NC | RR MEDICARE | OTHER | CC6608 | 01 | NC | RR MEDICARE | OTHER |