Provider Demographics
NPI:1811028582
Name:INGRID K. ROSKOS, MD, AMPC
Entity Type:Organization
Organization Name:INGRID K. ROSKOS, MD, AMPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:KARIN
Authorized Official - Last Name:ROSKOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-781-4848
Mailing Address - Street 1:1150 ROBERT BLVD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2004
Mailing Address - Country:US
Mailing Address - Phone:985-781-4848
Mailing Address - Fax:985-781-4850
Practice Address - Street 1:1150 ROBERT BLVD
Practice Address - Street 2:SUITE 360
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2004
Practice Address - Country:US
Practice Address - Phone:985-781-4848
Practice Address - Fax:985-781-4850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.14651R207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS457756369OtherBCBS OF MS PROVIDER NUMBER
MS05927851Medicaid
LA4577563690OtherBCBS OF LA PROVIDER NUMBER
LA1128767Medicaid
LA19D0964187OtherCLIA
LAH64133Medicare UPIN
LA5CD74Medicare PIN