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NPI Code Detail

MEDICARE: JAMES SPANOGLE

MEDICARE: JAMES SPANOGLE
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1639535321
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES SPANOGLE
Provider Business Mailing Address
First Line : 2198 HARRIS AVE NE
Second Line :
City : PALM BAY
State : FL
Zip : 32905-4002
Country : US
Telephone Number : 321-951-9750
Fax Number : 321-951-9765
Provider Business Practice Location Address
First Line : 2198 HARRIS AVE NE
Second Line :
City : PALM BAY
State : FL
Zip : 32905-4002
Country : US
Telephone Number : 321-951-9750
Fax Number : 321-951-9765
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2016
Last Update Date : 01/11/2016

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