NPI Code Details Logo

NPI 1457575656

NPI 1457575656 : SPRC, LLC : COLUMBIA, MD

=====================================================
General NPI Number Information
=====================================================
    NPI Number           |    1457575656
-----------------------------------------------------
    Entity Type          |    Organization 
-----------------------------------------------------
    Legal Business Name  |    SPRC, LLC 
-----------------------------------------------------

=====================================================
Dates
=====================================================
    Enumeration Date     |    04/12/2007
-----------------------------------------------------
    Last Update Date     |    11/05/2025
-----------------------------------------------------

=====================================================
Provider Practice Location Address
=====================================================
    Address Line         |    8860 COLUMBIA 100 PKWY STE 216 
-----------------------------------------------------
    City                 |    COLUMBIA
-----------------------------------------------------
    State                |    MD
-----------------------------------------------------
    Zip                  |    21045-2383
-----------------------------------------------------
    Country              |    US
-----------------------------------------------------
    Telephone            |    443-917-6500
-----------------------------------------------------
    Fax                  |    833-764-3847
-----------------------------------------------------

=====================================================
Provider Business Mailing Address
=====================================================
    Address Line         |    PO BOX 539 
-----------------------------------------------------
    City                 |    FULTON
-----------------------------------------------------
    State                |    MD
-----------------------------------------------------
    Zip                  |    20759-0539
-----------------------------------------------------
    Country              |    US
-----------------------------------------------------
    Telephone            |    443-917-6500
-----------------------------------------------------
    Fax                  |    833-764-3847
-----------------------------------------------------

=====================================================
Authorized Official
=====================================================
    Title or Position    |    PHYSICIAN
-----------------------------------------------------
    Name                 |     FRANCISCO  WARD 
-----------------------------------------------------
    Credential           |    DO
-----------------------------------------------------
    Telephone            |    443-917-6500
-----------------------------------------------------

=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
    Taxonomy Code        |    2081P2900X
-----------------------------------------------------
    Taxonomy Name        |    Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
    Taxonomy Code        |    208100000X
-----------------------------------------------------
    Taxonomy Name        |    Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
    Taxonomy Code        |    261QP3300X
-----------------------------------------------------
    Taxonomy Name        |    Pain Clinic/Center
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
    Taxonomy Code        |    2081H0002X
-----------------------------------------------------
    Taxonomy Name        |    Hospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
    License Number       |    H0045795
-----------------------------------------------------
    License Number State |    MD
-----------------------------------------------------



                        

Copyright © 2007-2025 Data Labs Health. All rights reserved.