Organization
T L SPRAGUE DO PC
Active
Other names
Audubon Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY L SPRAGUE DO (PRESIDENT OF PC)
(712) 563-4206
Entity
Organization
Contact information
Practice address
222 BROADWAY, AUDUBON MEDICAL CLINIC, AUDUBON, IA 50025-1199
(712) 563-4206
(712) 563-2001
Mailing address
222 BROADWAY, AUDUBON MEDICAL CLINIC, AUDUBON, IA 50025-1199
(712) 563-4206
(712) 563-2001
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0638536
—
IA
01
—
I3936
MEDICARE B GROUP #
IA
Enumeration date
05/15/2006
Last updated
01/18/2008
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