| J Kevin Ingram Medical, Inc | |
|
1806 Carter St Vidalia LA 71373-3115 | |
| (318) 757-6526 | |
| Not Available |
| Full Name | J Kevin Ingram Medical, Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 1806 Carter St, Vidalia, Louisiana |
| Authorized Official Name and Position | Johnny Kevin Ingram (OWNER) |
| Authorized Official Contact | 3183368166 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| J Kevin Ingram Medical, Inc Po Box 14149 Baton Rouge LA 70898-4149 Ph: (888) 924-9827 | J Kevin Ingram Medical, Inc 1806 Carter St Vidalia LA 71373-3115 Ph: (318) 757-6526 |
| NPI Number | 1871761619 |
|---|---|
| Provider Enumeration Date | 02/14/2008 |
| Last Update Date | 06/12/2008 |
| Medicare PECOS PAC ID | 7618051525 |
|---|---|
| Medicare Enrollment ID | O20080229000380 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871761619 | NPI | - | NPPES |
| 1066435 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | MD200671 (Louisiana) | Primary |
| Provider Name | Johnny K Ingram |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437100419 PECOS PAC ID: 3678585387 Enrollment ID: I20060621000168 |
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