1023237542 NPI number — JAMES C INGRAM JR MD INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023237542 NPI number — JAMES C INGRAM JR MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES C INGRAM JR MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VEIN CENTER OF LOUISIANA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023237542
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
155 HOSPITAL DR
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70503-2852
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-234-7777
Provider Business Mailing Address Fax Number:
337-237-3700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
155 HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70503-2852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-234-7777
Provider Business Practice Location Address Fax Number:
337-237-3700
Provider Enumeration Date:
04/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
INGRAM
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
C
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
337-234-7777

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD.011266 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1795810 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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