1336529262 NPI number — INGRAM & BALL, PLLC

Table of content: (NPI 1336529262)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336529262 NPI number — INGRAM & BALL, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INGRAM & BALL, PLLC
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:
HEARTLAND PRIMARY CARE PHARMACY
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:
1336529262
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3206 WILDWOOD TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA GRANGE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40031-8232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-939-6085
Provider Business Mailing Address Fax Number:
866-263-2295

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2412 RING RD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42701-5913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-765-5926
Provider Business Practice Location Address Fax Number:
866-263-2295
Provider Enumeration Date:
06/05/2015

Additional Information

Authorized Official

Authorized Official Last Name:
GREEN
Authorized Official First Name:
GARY
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
502-939-6085

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  P07691 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2152359 . This is a "PK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com