1255481883 NPI number — JIMMY W. SPRUILL M.D.

Table of content: JIMMY W. SPRUILL M.D. (NPI 1255481883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255481883 NPI number — JIMMY W. SPRUILL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPRUILL
Provider First Name:
JIMMY
Provider Middle Name:
W.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255481883
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3560 DELAWARE ST
Provider Second Line Business Mailing Address:
SUITE 601-A
Provider Business Mailing Address City Name:
BEAUMONT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77706-3067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-258-2016
Provider Business Mailing Address Fax Number:
409-924-9696

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1275 MARVIN HANCOCK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JASPER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75951-4935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-384-1951
Provider Business Practice Location Address Fax Number:
409-924-9696
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  F2033 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: F2033 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1399511-25 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8142853 . This is a "CIGNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8R0098 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 5645622 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00264261 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com