Provider Demographics
NPI:1245241892
Name:DENNIS CLIFFORD FORD MD
Entity Type:Organization
Organization Name:DENNIS CLIFFORD FORD MD
Other - Org Name:FORD CENTER FOR PAIN MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-614-0535
Mailing Address - Street 1:2020 KEITH ST NW
Mailing Address - Street 2:STE C
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-1351
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2020 KEITH ST NW
Practice Address - Street 2:STE C
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-1351
Practice Address - Country:US
Practice Address - Phone:423-614-0535
Practice Address - Fax:423-614-0545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN012143332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN337750Medicaid
4439421OtherNCPDP PROVIDER IDENTIFICATION NUMBER