MEDICARE: DR. JACK T SPROUL M.D.

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	207X00000X	Orthopaedic Surgery Physician	185796	NY
2	207X00000X	Orthopaedic Surgery Physician	0101254866	VA

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	:	1588644116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACK T SPROUL M.D.

Provider Business Mailing Address
First Line	:	101 DOCTORS PARK
Second Line	:
City	:	GALAX
State	:	VA
Zip	:	24333-2277
Country	:	US
Telephone Number	:	276-238-0990
Fax Number	:	276-238-1081

Provider Business Practice Location Address
First Line	:	101 DOCTORS PARK
Second Line	:
City	:	GALAX
State	:	VA
Zip	:	24333-2277
Country	:	US
Telephone Number	:	276-238-0990
Fax Number	:	276-238-1081

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	09/29/2015

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