Provider Demographics
NPI:1124015037
Name:GREGORY L. INGLE, D.O., P.C
Entity Type:Organization
Organization Name:GREGORY L. INGLE, D.O., P.C
Other - Org Name:PRAIRIE CITY FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:INGLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:515-994-2617
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50228-0430
Mailing Address - Country:US
Mailing Address - Phone:515-994-2617
Mailing Address - Fax:515-994-2365
Practice Address - Street 1:100 E JEFFERSON ST.
Practice Address - Street 2:
Practice Address - City:PRAIRIE CITY
Practice Address - State:IA
Practice Address - Zip Code:50228
Practice Address - Country:US
Practice Address - Phone:515-994-2617
Practice Address - Fax:515-994-2365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0283655Medicaid
IAO1813Medicare ID - Type Unspecified