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Timothy Ford

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

700 S Zarzamora St Ste 310, San Antonio, TX 78207-5249

PECOS Enrollment

Based on the most recent information from CMS, provider Timothy Ford is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records today at 9:43 AM.

Profile Details

Provider ID
1053718197
Provider Type
Individual
Full Name
Ford, Timothy
Title
Mr.
Credential
FNP

Gender
Male
Sole Proprietor
No
Enumeration Date
12/3/2014
Last Updated
10/11/2023

Contact Information

Practice Location

700 S Zarzamora St Ste 310, San Antonio, TX 78207-5249

(210) 998-2240

(210) 616-2204

Mailing Location

6756 Stonykirk Rd, San Antonio, TX 78240-2483

(210) 990-8779

(210) 616-2204

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License AP127039 Texas

Provider Identifiers

ID	Description	Issuer
ID 350729502	Description Medicaid	Issuer Unlisted Texas
ID 350729503	Description Other	Issuer CSHCN Texas

Timothy Ford

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

Reddy, Janie Anu

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Trinkl, Suzanne Catherine

Lucio, Virginia Christina

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Elo, Lyannette Calderon

Mcmullen, Katherine Roberts

Brown, Tracy Devon

Harb, Lisette

Tejada, Allan Francis