MEDICARE: GREGORY L. INGLE, D.O., P.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	207Q00000X	Family Medicine Physician

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

General Provider Information

NPI Number	:	1124015037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREGORY L. INGLE, D.O., P.C

Provider Business Mailing Address
First Line	:	PO BOX 430
Second Line	:
City	:	PRAIRIE CITY
State	:	IA
Zip	:	50228-0430
Country	:	US
Telephone Number	:	515-994-2617
Fax Number	:	515-994-2365

Provider Business Practice Location Address
First Line	:	100 E JEFFERSON ST.
Second Line	:
City	:	PRAIRIE CITY
State	:	IA
Zip	:	50228
Country	:	US
Telephone Number	:	515-994-2617
Fax Number	:	515-994-2365

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GREGORY LEE INGLE
Credential	:	D.O.
Telephone Number	:	515-994-2617

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	08/22/2020

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