Richard D Ford, PA
Individual provider Active NPI Physician Assistant · St Joseph, MO
NPI 1710955596 · NPPES record last updated Aug 15, 2016
Key facts
- NPI
- 1710955596
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 109841 (MO)
- Practice address
- 1515 St Joseph Ave
St Joseph, MO 64505-2631 - Phone
- (816) 233-3338
- Fax
- (816) 233-4777
- NPI assigned
- Mar 9, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 109841 | MO | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northwest Health Services Inc | Past | Accepting new patients | |
| Northwest Health Services Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 109841 | MO | Yes |
Addresses
Primary practice location
1515 St Joseph Ave
St Joseph, MO 64505-2631
Mailing address
3203 Middle Road
Columbus, IN 47203-4427
Phone (812) 373-2700
Other providers in St Joseph, MO
- Frances Dea Flynt
- Fohdc LLC
- Scott Michael Folk
- Brittany Fonseca
- Carmen Marie Ford
- Brent Daniel Forrest
- Mandy Jean Forret
- Trey Kyle Forward
- David R Foster
- Foundation Recovery Center
All providers in St Joseph, MO · Physician Assistant in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 15, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.