Provider Demographics
NPI:1023237542
Name:JAMES C INGRAM JR MD INC
Entity type:Organization
Organization Name:JAMES C INGRAM JR MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:337-234-7777
Mailing Address - Street 1:155 HOSPITAL DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2852
Mailing Address - Country:US
Mailing Address - Phone:337-234-7777
Mailing Address - Fax:337-237-3700
Practice Address - Street 1:155 HOSPITAL DR
Practice Address - Street 2:SUITE 201
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2852
Practice Address - Country:US
Practice Address - Phone:337-234-7777
Practice Address - Fax:337-237-3700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.011266174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1795810Medicaid
LA57389Medicare PIN
LA1795810Medicaid