MEDICARE: MR. WILLIAM INGRAM PA-C

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
2	363A00000X	Physician Assistant	PA9104087	FL
3	363A00000X	Physician Assistant	10002420A	IN
4	363A00000X	Physician Assistant	50.002024RX	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366415283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM INGRAM PA-C

Provider Business Mailing Address
First Line	:	9776 OLDE GEORGETOWN
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45458-6103
Country	:	US
Telephone Number	:	937-938-8187
Fax Number	:

Provider Business Practice Location Address
First Line	:	1130 S MAIN ST
Second Line	:
City	:	ENGLEWOOD
State	:	OH
Zip	:	45322-2819
Country	:	US
Telephone Number	:	937-208-6879
Fax Number	:	937-208-6886

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

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	05/21/2025

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Directions to “ MR. WILLIAM INGRAM PA-C” Practice Location

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