MEDICARE: JAIME E FORD ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083S0010X	Sports Medicine (Preventive Medicine) Physician	AT802	KY

General Provider Information

NPI Number	:	1285990259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAIME E FORD ATC

Provider Business Mailing Address
First Line	:	1723 WINDSOR AVE.,
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42301
Country	:	US
Telephone Number	:	270-316-4360
Fax Number	:

Provider Business Practice Location Address
First Line	:	1723 WINDSOR AVE.,
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42301
Country	:	US
Telephone Number	:	270-316-4360
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2012
Last Update Date	:	04/04/2012

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Directions to “ JAIME E FORD ATC” Practice Location

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