Provider Demographics
NPI:1265511463
Name:INGRAM INVESTMENTS LLC
Entity Type:Organization
Organization Name:INGRAM INVESTMENTS LLC
Other - Org Name:THE SURGICAL CENTER OF MIDLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:P
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-694-6517
Mailing Address - Street 1:2706 WEST CUTHBERT
Mailing Address - Street 2:BUILDING A
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701
Mailing Address - Country:US
Mailing Address - Phone:432-694-6517
Mailing Address - Fax:432-694-7414
Practice Address - Street 1:2706 WEST CUTHBERT
Practice Address - Street 2:BUILDING A
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701
Practice Address - Country:US
Practice Address - Phone:432-694-6517
Practice Address - Fax:432-694-7414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000398207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH1502OtherBLUE CROSS BLUE SHIELD
TXASC023Medicare ID - Type Unspecified