1316990245 NPI number — THOMAS R. SPRUILL, M.D., P.A.

Table of content: (NPI 1316990245)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316990245 NPI number — THOMAS R. SPRUILL, M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS R. SPRUILL, M.D., P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1316990245
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3900 BROWNING PL
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27609-6508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-787-7125
Provider Business Mailing Address Fax Number:
919-781-9952

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3900 BROWNING PL
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27609-6508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-787-7125
Provider Business Practice Location Address Fax Number:
919-781-9952
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SPRUILL
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
919-787-7125

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  29803 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 79054 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8979054 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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