Provider Demographics
NPI:1134426919
Name:INGENIOS HEALTH CO.
Entity type:Organization
Organization Name:INGENIOS HEALTH CO.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TALCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-294-5194
Mailing Address - Street 1:2500 LEGACY DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-5983
Mailing Address - Country:US
Mailing Address - Phone:972-704-7263
Mailing Address - Fax:
Practice Address - Street 1:2500 LEGACY DR
Practice Address - Street 2:SUITE 206
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-5983
Practice Address - Country:US
Practice Address - Phone:972-704-7263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB129270Medicare PIN
PA214129Medicare PIN