=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376837666
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPANG INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2011
-----------------------------------------------------
Last Update Date | 06/03/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8405 SW 80TH ST SUITE 14
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34481-9121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-620-8484
-----------------------------------------------------
Fax | 352-620-8415
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8405 SW 80TH ST SUITE 14
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34481-9121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-620-8484
-----------------------------------------------------
Fax | 352-620-8415
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR/OWNER
-----------------------------------------------------
Name | MR. JOHN THOMAS SPANG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 352-620-8484
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 30211451
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------