Organization
FORD, SIMPSON, LIVELY & RICE PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN W CAGLE (CHEIF RISK MANAGEMENT OFFICER)
(336) 802-2406
Entity
Organization
Contact information
Practice address
2909 MAPLEWOOD AVE, WINSTON SALEM, NC 27103-4009
(336) 794-3380
(336) 794-3378
Mailing address
2909 MAPLEWOOD AVE, WINSTON SALEM, NC 27103-4009
(336) 794-3380
(336) 794-3378
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020E1
BCBS GROUP
NC
05
—
5905488
—
NC
05
—
5909124
—
NC
05
—
89015U1
—
NC
05
—
8901759
—
NC
01
—
CB8658
RR MEDICARE
NC
01
—
CC4241
RR MEDICARE
NC
01
—
CC4242
RR MEDICARE
NC
01
—
CC4243
RR MEDICARE
NC
01
—
CC5472
RR MEDICARE
NC
01
—
CC6608
RR MEDICARE
NC
01
—
CD6614
RR MEDICARE
NC
01
—
CF9200
RR MEDICARE
NC
Enumeration date
06/22/2006
Last updated
05/13/2009
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