Healthcare Provider Details

I. General information

NPI: 1376706135
Provider Name (Legal Business Name): TERRANCE L FORD HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226200 RIB MOUNTAIN DR
RIB MOUNTAIN WI
54401-3347
US

IV. Provider business mailing address

226200 RIB MOUNTAIN DR
RIB MOUNTAIN WI
54401-3347
US

V. Phone/Fax

Practice location:
  • Phone: 715-841-4879
  • Fax:
Mailing address:
  • Phone: 715-841-4879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1294-060
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: