Healthcare Provider Details

I. General information

NPI: 1619009065
Provider Name (Legal Business Name): FORD CENTER FOR PAIN MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 KEITH ST NW STE C
CLEVELAND TN
37311-1351
US

IV. Provider business mailing address

2020 KEITH ST NW STE C
CLEVELAND TN
37311-1351
US

V. Phone/Fax

Practice location:
  • Phone: 423-614-0535
  • Fax: 423-614-0545
Mailing address:
  • Phone: 423-614-0535
  • Fax: 423-614-0545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number10501
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12143
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number1196
License Number StateTN

VIII. Authorized Official

Name: DENNIS C. FORD
Title or Position: OWNER SUPERVISING M.D.
Credential: MD
Phone: 423-614-0535