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NPI Code Detail

MEDICARE: JACOB RYAN SPRUELL

MEDICARE: JACOB RYAN SPRUELL
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1639994940
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB RYAN SPRUELL
Provider Business Mailing Address
First Line : 2320 BROAD ROCK BLVD
Second Line :
City : RICHMOND
State : VA
Zip : 23224-4812
Country : US
Telephone Number : 804-276-6059
Fax Number :
Provider Business Practice Location Address
First Line : 2501 TURNER RD
Second Line :
City : NORTH CHESTERFIELD
State : VA
Zip : 23224-2537
Country : US
Telephone Number : 804-276-6059
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2024
Last Update Date : 11/21/2024

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