Provider Demographics
NPI:1427704691
Name:PATIENT ACCESS FOUNDATION
Entity type:Organization
Organization Name:PATIENT ACCESS FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:DENARD
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:APRN,NP-C,FNP-BC
Authorized Official - Phone:903-417-5377
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:DE KALB
Mailing Address - State:TX
Mailing Address - Zip Code:75559-0369
Mailing Address - Country:US
Mailing Address - Phone:903-417-5377
Mailing Address - Fax:
Practice Address - Street 1:118 WOOD ST
Practice Address - Street 2:
Practice Address - City:DE KALB
Practice Address - State:TX
Practice Address - Zip Code:75559-2112
Practice Address - Country:US
Practice Address - Phone:903-417-5377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-26
Last Update Date:2022-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center