Basic Information
| Provider Information | |||||||||
| NPI: | 1609033802 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FORD | ||||||||
| FirstName: | JAMES | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3923 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711333923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006840052 | ||||||||
| FaxNumber: | 4058441794 | ||||||||
| Practice Location | |||||||||
| Address1: | 240 HIGHLAND DR | ||||||||
| Address2: | EMERGENCY DEPT | ||||||||
| City: | MANY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 714493718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058441830 | ||||||||
| FaxNumber: | 4053419217 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2008 | ||||||||
| LastUpdateDate: | 04/11/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 204379 | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 05510 | 05 | LA | MEDICAID | 1055107 | 05 | LA | MEDICAID |