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General NPI Number Information
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NPI Number | 1316998289
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Entity Type | Organization
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Legal Business Name | T L SPRAGUE DO PC
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 01/18/2008
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Provider Practice Location Address
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Address Line | 222 BROADWAY AUDUBON MEDICAL CLINIC
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City | AUDUBON
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State | IA
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Zip | 50025-1199
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Country | US
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Telephone | 712-563-4206
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Fax | 712-563-2001
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Provider Business Mailing Address
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Address Line | 222 BROADWAY AUDUBON MEDICAL CLINIC
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City | AUDUBON
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State | IA
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Zip | 50025-1199
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Country | US
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Telephone | 712-563-4206
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Fax | 712-563-2001
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Authorized Official
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Title or Position | PRESIDENT OF PC
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Name | TERRY L SPRAGUE
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Credential | DO
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Telephone | 712-563-4206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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