1992989289 NPI number — CARL G PURVIS, DPM PA

Table of content: (NPI 1992989289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992989289 NPI number — CARL G PURVIS, DPM PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARL G PURVIS, DPM PA
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:
PURVIS FOOT & ANKLE CENTER
Provider Other Organization Name Type Code:
3
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:
1992989289
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3301 SUNSET AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKY MOUNT
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27804-3521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-443-7114
Provider Business Mailing Address Fax Number:
252-443-7115

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3301 SUNSET AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKY MOUNT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27804-3521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-443-7114
Provider Business Practice Location Address Fax Number:
252-443-7115
Provider Enumeration Date:
12/21/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WARREN
Authorized Official First Name:
BEVERLY
Authorized Official Middle Name:
T
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
252-443-7114

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  96 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 277485 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 394110 . This is a "PHCS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 8908144 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 255232 . This is a "MAMSI" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 58299 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5396408 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6856119 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".