Basic Information
| Provider Information | |||||||||
| NPI: | 1376663187 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FORD | ||||||||
| FirstName: | JASON | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1595 | ||||||||
| Address2: | |||||||||
| City: | ASHLAND | ||||||||
| State: | KY | ||||||||
| PostalCode: | 411051595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6064089571 | ||||||||
| FaxNumber: | 6064086061 | ||||||||
| Practice Location | |||||||||
| Address1: | 2910 CARTER AVE | ||||||||
| Address2: | |||||||||
| City: | ASHLAND | ||||||||
| State: | KY | ||||||||
| PostalCode: | 411011943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6063247337 | ||||||||
| FaxNumber: | 6063269596 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2007 | ||||||||
| LastUpdateDate: | 11/18/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 40959 | KY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 000000526773 | 01 | KY | ANTHEM BCBS | OTHER | 000000598472 | 01 | KY | ANTHEM BCBS | OTHER | 2757913 | 05 | OH | MEDICAID | 7100012910 | 05 | KY | MEDICAID |