MEDICARE: DAVID B FORD C.S.T.

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	246ZS0410X	Surgical Technologist

General Provider Information

NPI Number	:	1619120839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID B FORD C.S.T.

Provider Business Mailing Address
First Line	:	3951 CENTURY DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-3172
Country	:	US
Telephone Number	:	970-223-4598
Fax Number	:	970-631-8255

Provider Business Practice Location Address
First Line	:	3951 CENTURY DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-3172
Country	:	US
Telephone Number	:	970-223-4598
Fax Number	:	970-631-8255

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

Provider Enumeration Date	:	10/31/2008
Last Update Date	:	10/31/2008

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