Provider Demographics
NPI:1881659654
Name:TEDFORD, CHRISTOPHER PRICE (NURSE)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:PRICE
Last Name:TEDFORD
Suffix:
Gender:M
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9385 STATE ROUTE #28
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:OH
Mailing Address - Zip Code:45628
Mailing Address - Country:US
Mailing Address - Phone:740-998-6364
Mailing Address - Fax:740-998-6577
Practice Address - Street 1:9385 STATE ROUTE 28
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:OH
Practice Address - Zip Code:45628-9750
Practice Address - Country:US
Practice Address - Phone:740-998-6364
Practice Address - Fax:740-998-6577
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN077448164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2063887Medicaid