MEDICARE: TERRELL INGRAM

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	332U00000X	Home Delivered Meals

General Provider Information

NPI Number	:	1356855571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRELL INGRAM

Provider Business Mailing Address
First Line	:	2276 VOIT CIR
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-1536
Country	:	US
Telephone Number	:	614-507-5953
Fax Number	:

Provider Business Practice Location Address
First Line	:	2276 VOIT CIR
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-1536
Country	:	US
Telephone Number	:	614-507-5953
Fax Number	:

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

Provider Enumeration Date	:	11/27/2017
Last Update Date	:	11/27/2017

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Directions to “ TERRELL INGRAM ” Practice Location

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