Provider Demographics
NPI:1578819033
Name:INGRAM CO
Entity Type:Organization
Organization Name:INGRAM CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCARAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-946-2730
Mailing Address - Street 1:367 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-8984
Mailing Address - Country:US
Mailing Address - Phone:615-946-2730
Mailing Address - Fax:
Practice Address - Street 1:367 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-8984
Practice Address - Country:US
Practice Address - Phone:615-946-2730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-01
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31548207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Single Specialty