Provider Demographics
NPI:1063497774
Name:FORD CENTER FOR FOOT SURGERY INC
Entity Type:Organization
Organization Name:FORD CENTER FOR FOOT SURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:L
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:775-331-1919
Mailing Address - Street 1:2321 PYRAMID WAY
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-8700
Mailing Address - Country:US
Mailing Address - Phone:775-331-1919
Mailing Address - Fax:775-331-2008
Practice Address - Street 1:2321 PYRAMID WAY
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-8700
Practice Address - Country:US
Practice Address - Phone:775-331-1919
Practice Address - Fax:775-331-2008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA75ASC-9261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCH8729OtherRR GROUP PROV. #
NVCH8729OtherRR GROUP PROV. #
NV6040240001Medicare NSC