Provider Demographics
NPI:1023632619
Name:INGRAM HEALTH CONSULTING
Entity type:Organization
Organization Name:INGRAM HEALTH CONSULTING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:DENARD
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:903-280-8173
Mailing Address - Street 1:118 WOOD ST OFC 1
Mailing Address - Street 2:
Mailing Address - City:DE KALB
Mailing Address - State:TX
Mailing Address - Zip Code:75559-2112
Mailing Address - Country:US
Mailing Address - Phone:903-280-8173
Mailing Address - Fax:
Practice Address - Street 1:1250 S RUNNELS ST
Practice Address - Street 2:
Practice Address - City:DE KALB
Practice Address - State:TX
Practice Address - Zip Code:75559-2317
Practice Address - Country:US
Practice Address - Phone:903-280-8173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INGRAM HEALTH CONSULTING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-30
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No251S00000XAgenciesCommunity/Behavioral Health