HEART GROUP OF THE EASTERN SHORE, P.C.

Provider Demographics

• NPI: 1609095157
• Name: HEART GROUP OF THE EASTERN SHORE, P.C.
• Entity Type: Organization
• Organization Name: HEART GROUP OF THE EASTERN SHORE, P.C.
• Other - Org Name: MICHAEL S. PURLSEY MD PC
• Other - Org Type: Former Legal Business Name
• Authorized Official - Title/Position: PRESIDENT/OWNER
• Authorized Official - Prefix: DR
• Authorized Official - First Name: MICHAEL
• Authorized Official - Middle Name: S
• Authorized Official - Last Name: PURSLEY
• Authorized Official - Credentials: MD
• Authorized Official - Phone: 251-990-1920
• Mailing Address - Street 1: PO BOX 850266
• Mailing Address - City: MOBILE
• Mailing Address - State: AL
• Mailing Address - Zip Code: 36685-0266
• Mailing Address - Country: US
• Mailing Address - Phone: 251-990-1920
• Mailing Address - Fax: 251-990-1921
• Practice Address - Street 1: 150 S. INGLESIDE STREET
• Practice Address - Street 2: #4 MEDICAL PARK
• Practice Address - City: FAIRHOPE
• Practice Address - State: AL
• Practice Address - Zip Code: 36532-1804
• Practice Address - Country: US
• Practice Address - Phone: 251-990-1920
• Practice Address - Fax: 251-990-1921
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2007-04-24
• Last Update Date: 2013-12-09

Provider Licenses

State	License ID	Taxonomies
AL	25610	174400000X
		261Q00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	261Q00000X	Ambulatory Health Care Facilities	Clinic/Center
No	174400000X	Other Service Providers	Specialist		Group - Single Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
AL	009936436	Medicaid
AL	009936467	Medicaid
AL	1609095157	Other	GRP NPI
AL	51503479	Other	BC/MC
AL	DE4413	Other	RR MEDICARE FOR GROUP
AL	009936433	Medicaid
AL	051554382	Medicaid
MS	05538519	Medicaid
AL	1467430777	Other	NPI
AL	1689678674	Other	BRAND NPI
AL	K814	Other	MEDICARE GRP
AL	529927690	Other	GRP MEDICAID
AL	51541652	Other	MEDICARE BRAND
AL	P00082012	Other	RR MEDICARE
AL	009936434	Medicaid
AL	009936467	Medicaid
AL	009936433	Medicaid
AL	051554382	Medicaid
AL	051557407	Medicare PIN
AL	K814	Medicare UPIN