Provider Demographics
NPI:1619009065
Name:FORD CENTER FOR PAIN MANAGEMENT
Entity Type:Organization
Organization Name:FORD CENTER FOR PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER SUPERVISING M.D.
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
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:423-614-0535
Mailing Address - Fax:423-614-0545
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:2007-03-12
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10501207LP2900X
TN12143207Q00000X
TN1196208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3377550OtherMEDICARE GROUP
TN4041359OtherMD BLUE CROSS BLUE SHIELD
TN44D1041380OtherDEPT HEALTH CLIA
TN3377550Medicaid
TN5108340001Medicare NSC