Provider Demographics
NPI:1376872192
Name:SPRINKLE, JEFF WAYNE (CPO)
Entity Type:Individual
Prefix:MR
First Name:JEFF
Middle Name:WAYNE
Last Name:SPRINKLE
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 S PINE ST
Mailing Address - Street 2:A
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-2650
Mailing Address - Country:US
Mailing Address - Phone:864-591-2242
Mailing Address - Fax:864-591-2037
Practice Address - Street 1:383 S PINE ST
Practice Address - Street 2:A
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-2650
Practice Address - Country:US
Practice Address - Phone:864-591-2242
Practice Address - Fax:864-591-2037
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC13768721921OtherINDIVIDUAL NPI NUMBER
SCDE2685Medicaid
NC7795443Medicaid
NC7795443Medicaid