Provider Demographics
NPI:1184800260
Name:SPRAGUE FAMILY PRACTICE, P.C.
Entity type:Organization
Organization Name:SPRAGUE FAMILY PRACTICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:SPRAGUE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:978-597-8166
Mailing Address - Street 1:PO BOX 563
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:MA
Mailing Address - Zip Code:01469-0563
Mailing Address - Country:US
Mailing Address - Phone:978-597-8166
Mailing Address - Fax:978-597-0061
Practice Address - Street 1:120 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:TOWNSEND
Practice Address - State:MA
Practice Address - Zip Code:01469-1128
Practice Address - Country:US
Practice Address - Phone:978-597-8166
Practice Address - Fax:978-597-0061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0005497Medicare PIN