1700859196 NPI number — WILSON B SPRENKLE MD

Table of content: WILSON B SPRENKLE MD (NPI 1700859196)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700859196 NPI number — WILSON B SPRENKLE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPRENKLE
Provider First Name:
WILSON
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1700859196
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 31872
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23294-1872
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-266-8717
Provider Business Mailing Address Fax Number:
804-266-5677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6105 HEALTH CENTER LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREDERICKSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-786-5262
Provider Business Practice Location Address Fax Number:
540-786-5299
Provider Enumeration Date:
02/08/2006

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: 2085R0001X , with the licence number:  0101026596 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 14Z596 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0004115158 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 226153 . This is a "SOUTHERN HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00063506 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1471540 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3100597 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3392300 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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