Provider Demographics
NPI:1376086116
Name:PURCELL INTEGRATIVE OSTEOPATHIC CLINIC
Entity Type:Organization
Organization Name:PURCELL INTEGRATIVE OSTEOPATHIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PURCELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:518-810-5002
Mailing Address - Street 1:140 16TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTHUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17857-9402
Mailing Address - Country:US
Mailing Address - Phone:518-810-5002
Mailing Address - Fax:
Practice Address - Street 1:353 MARKET ST
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:PA
Practice Address - Zip Code:17801-3403
Practice Address - Country:US
Practice Address - Phone:570-975-1615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1306139332OtherNPPES