# J KEVIN INGRAM MEDICAL, INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871761619
- **Authorized official:** JOHNNY KEVIN INGRAM MD (OWNER)
- **Authorized official phone:** (318) 336-8166

## Contact information

- **Practice address:** 1806 CARTER ST, VIDALIA, LA 71373-3115
- **Practice address phone:** (318) 757-6526
- **Mailing address:** PO BOX 14149, BATON ROUGE, LA 70898-4149
- **Mailing address phone:** (888) 924-9827
- **Mailing address fax:** (225) 924-9829

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | MD200671 | LA | Yes |

## Other

- **Enumeration date:** 02/14/2008
- **Last updated:** 06/12/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1066435 | — | LA |