NPIMap

Organization Active NPI

Ingram Mall FDC PA

  • Dentist
  • San Antonio, TX
National Provider Identifier
1992963136
Registry record updated May 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
0008481 Issued in TX
Legal business name
INGRAM MALL FDC PA
Practice address
6301 N.W. Loop 410
Ste L1A
San Antonio, TX 78238-3824
Phone
(210) 354-4867
Fax
(210) 681-6985
NPI assigned
May 23, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lynn Armstrong
Title
Regional Manager
Phone
(505) 328-4867

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 0008481 TX Primary

Addresses

Primary practice location

6301 N.W. Loop 410
Ste L1A
San Antonio, TX 78238-3824

Mailing address

6301 N.W. Loop 410
Ste L1A
San Antonio, TX 78238-3824
Phone (210) 354-4867

National Provider Directory

National Provider Directory
Tax ID family
Ingram Mall FDC PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1211500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211500800000",
    "number": "1992963136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6301 N.W. LOOP 410",
            "address_2": "STE L1A",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782383824",
            "telephone_number": "210-354-4867",
            "fax_number": "210-681-6985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6301 N.W. LOOP 410",
            "address_2": "STE L1A",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782383824",
            "telephone_number": "210-354-4867",
            "fax_number": "210-681-6985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INGRAM MALL FDC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-23",
        "last_updated": "2008-05-23",
        "status": "A",
        "authorized_official_last_name": "ARMSTRONG",
        "authorized_official_first_name": "LYNN",
        "authorized_official_title_or_position": "REGIONAL MANAGER",
        "authorized_official_telephone_number": "505-328-4867"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "0008481",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.