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316 Maple Tree Ln Spring Grove VA 23881-8515 | |
| (804) 955-0965 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 316 Maple Tree Ln, Spring Grove, Virginia |
| Authorized Official Name and Position | Rebecca Harding Ingram (CEO, PHYSICIAN) |
| Authorized Official Contact | 8049550965 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
316 Maple Tree Ln Spring Grove VA 23881-8515 Ph: (804) 955-0965 | 316 Maple Tree Ln Spring Grove VA 23881-8515 Ph: (804) 955-0965 |
| NPI Number | 1821381427 |
|---|---|
| Provider Enumeration Date | 05/16/2011 |
| Last Update Date | 05/16/2011 |
| Medicare PECOS PAC ID | 3274710066 |
|---|---|
| Medicare Enrollment ID | O20110603000114 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821381427 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 0101242147 (Virginia) | Primary |
| Provider Name | Rebecca Jill Ingram |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1275861817 PECOS PAC ID: 7012057631 Enrollment ID: I20091211000606 |