Provider Demographics
NPI:1821255001
Name:CARL G PURVIS DPM PA
Entity Type:Organization
Organization Name:CARL G PURVIS DPM PA
Other - Org Name:PURVIS-MOYER FOOT & ANKLE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:H
Authorized Official - Last Name:PURVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:252-443-7114
Mailing Address - Street 1:3301 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-3521
Mailing Address - Country:US
Mailing Address - Phone:252-443-7114
Mailing Address - Fax:252-443-7115
Practice Address - Street 1:3301 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-3521
Practice Address - Country:US
Practice Address - Phone:252-443-7114
Practice Address - Fax:252-443-7115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908144Medicaid
NC243043Medicare PIN