Provider Demographics
NPI:1326223520
Name:INGE, MACARTHUR
Entity Type:Individual
Prefix:MR
First Name:MACARTHUR
Middle Name:
Last Name:INGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3413 CAMELLIA CIRCLE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-1736
Mailing Address - Country:US
Mailing Address - Phone:662-327-3643
Mailing Address - Fax:663-328-9806
Practice Address - Street 1:3413 CAMELLIA CIRCLE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-1736
Practice Address - Country:US
Practice Address - Phone:662-327-3643
Practice Address - Fax:663-328-9806
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02488536Medicaid