1609095157 NPI number — HEART GROUP OF THE EASTERN SHORE, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609095157 NPI number — HEART GROUP OF THE EASTERN SHORE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEART GROUP OF THE EASTERN SHORE, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MICHAEL S. PURLSEY MD PC
Provider Other Organization Name Type Code:
4
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:
1609095157
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 850266
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36685-0266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-990-1920
Provider Business Mailing Address Fax Number:
251-990-1921

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 S. INGLESIDE STREET
Provider Second Line Business Practice Location Address:
#4 MEDICAL PARK
Provider Business Practice Location Address City Name:
FAIRHOPE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36532-1804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-990-1920
Provider Business Practice Location Address Fax Number:
251-990-1921
Provider Enumeration Date:
04/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PURSLEY
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
251-990-1920

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  25610 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 009936436 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009936467 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1609095157 . This is a "GRP NPI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51503479 . This is a "BC/MC" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: DE4413 . This is a "RR MEDICARE FOR GROUP" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009936433 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051554382 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05538519 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1467430777 . This is a "NPI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1689678674 . This is a "BRAND NPI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: K814 . This is a "MEDICARE GRP" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 529927690 . This is a "GRP MEDICAID" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51541652 . This is a "MEDICARE BRAND" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: P00082012 . This is a "RR MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009936434 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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