MEDICARE: MAISHA FORD

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1336684950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAISHA FORD

Provider Business Mailing Address
First Line	:	825 NE 70TH ST
Second Line	:	OKLAHOMA CITY
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73105-6009
Country	:	US
Telephone Number	:	405-831-7649
Fax Number	:

Provider Business Practice Location Address
First Line	:	825 NE 70TH ST
Second Line	:	OKLAHOMA CITY
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73105-6009
Country	:	US
Telephone Number	:	405-831-7649
Fax Number	:

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

Provider Enumeration Date	:	01/05/2017
Last Update Date	:	01/05/2017

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Directions to “ MAISHA FORD ” Practice Location

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