| Sprague Medical Corp | |
|
1582 W San Marcos Blvd Ste 100 San Marcos CA 92078-4081 | |
| (619) 337-4951 | |
| Not Available |
| Full Name | Sprague Medical Corp |
|---|---|
| Speciality | Internal Medicine |
| Location | 1582 W San Marcos Blvd Ste 100, San Marcos, California |
| Authorized Official Name and Position | Tyler Lee Sprague (PRESIDENT) |
| Authorized Official Contact | 6193374951 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sprague Medical Corp 3339 Tyler St Carlsbad CA 92008-3056 Ph: (619) 337-4951 | Sprague Medical Corp 1582 W San Marcos Blvd Ste 100 San Marcos CA 92078-4081 Ph: (619) 337-4951 |
| NPI Number | 1689487571 |
|---|---|
| Provider Enumeration Date | 01/27/2025 |
| Last Update Date | 01/27/2025 |
| Medicare PECOS PAC ID | 4981126372 |
|---|---|
| Medicare Enrollment ID | O20250314000885 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689487571 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Tyler L Sprague |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1881077428 PECOS PAC ID: 5092076133 Enrollment ID: I20180306000489 |
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