MEDICARE: MR. JAMES L SPROUSE PA-C

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
1	363A00000X	Physician Assistant	PA082	ME

General Provider Information

NPI Number	:	1992782718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES L SPROUSE PA-C

Provider Business Mailing Address
First Line	:	15 COVE RD
Second Line	:
City	:	WINTERPORT
State	:	ME
Zip	:	04496-3821
Country	:	US
Telephone Number	:	207-223-5574
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 ARSENAL ST
Second Line	:	11 SHS
City	:	AUGUSTA
State	:	ME
Zip	:	04333-0011
Country	:	US
Telephone Number	:	207-624-4657
Fax Number	:	207-287-6123

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	07/08/2007

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