Provider Demographics
NPI:1891967238
Name:RALPH B FORD III PC
Entity Type:Organization
Organization Name:RALPH B FORD III PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:III
Authorized Official - Credentials:EDD
Authorized Official - Phone:231-946-6235
Mailing Address - Street 1:909 GRAY RD
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-9219
Mailing Address - Country:US
Mailing Address - Phone:231-946-6235
Mailing Address - Fax:231-946-1859
Practice Address - Street 1:909 GRAY RD
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-9219
Practice Address - Country:US
Practice Address - Phone:231-946-6235
Practice Address - Fax:231-946-1859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIR66729Medicare UPIN