1467430777 NPI number — MICHAEL S PURSLEY MD

Table of content: MICHAEL S PURSLEY MD (NPI 1467430777)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467430777 NPI number — MICHAEL S PURSLEY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PURSLEY
Provider First Name:
MICHAEL
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1467430777
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/10/2015
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 ST
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:
36532-1803
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:
01/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

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: "Y" .

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

  • 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: 1609095157 . This is a "MEDICARE GROUP NPI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 05538519 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1467430777 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: K814 . This is a "MEDICARE GROUP" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • 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: 009936434 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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