MEDICARE: WILLIAM SILAS VINSON PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	10004614A	IN

General Provider Information

NPI Number	:	1346063690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM SILAS VINSON PA

Provider Business Mailing Address
First Line	:	9615 E 148TH ST STE 1
Second Line	:
City	:	NOBLESVILLE
State	:	IN
Zip	:	46060-4371
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 SHELBY ST RM 101103
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-3943
Country	:	US
Telephone Number	:	317-574-1254
Fax Number	:	317-674-0060

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2024
Last Update Date	:	03/16/2026

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