Healthcare Provider Details

I. General information

NPI: 1396750022
Provider Name (Legal Business Name): INGRAM & BALL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 05/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2412 RING RD SUITE 200
ELIZABETHTOWN KY
42701-7998
US

IV. Provider business mailing address

2412 RING RD SUITE 200
ELIZABETHTOWN KY
42701-7998
US

V. Phone/Fax

Practice location:
  • Phone: 270-765-5926
  • Fax: 270-763-0051
Mailing address:
  • Phone: 270-765-5926
  • Fax: 270-763-0051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS G INGRAM
Title or Position: OWNER
Credential: MD
Phone: 270-765-5926