Provider Demographics
NPI:1629798251
Name:PURELY VASECTOMIES LLC
Entity Type:Organization
Organization Name:PURELY VASECTOMIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WOODMANSEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:602-799-2251
Mailing Address - Street 1:330 W MONTEBELLO AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-1847
Mailing Address - Country:US
Mailing Address - Phone:602-799-2251
Mailing Address - Fax:
Practice Address - Street 1:12320 N 32ND ST STE 2
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-7154
Practice Address - Country:US
Practice Address - Phone:602-799-2251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty