1225173313 NPI number — CINDY LEE INGRAM C.R.N.A.

Table of content: CINDY LEE INGRAM C.R.N.A. (NPI 1225173313)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225173313 NPI number — CINDY LEE INGRAM C.R.N.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
INGRAM
Provider First Name:
CINDY
Provider Middle Name:
LEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
C.R.N.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
INGRAM
Provider Other First Name:
CINDY
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1225173313
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
272 HOSPITAL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHILLICOTHE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45601-9031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-779-7540
Provider Business Mailing Address Fax Number:
740-779-7867

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 DAWN LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAVERLY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45690-9138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-947-6391
Provider Business Practice Location Address Fax Number:
740-947-6538
Provider Enumeration Date:
02/20/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  NA-08616 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 311072406 . This is a "3RD PARTY PAYERS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2465943 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".