Provider Demographics
NPI:1891944195
Name:CARL G PURVIS DPM PA
Entity Type:Organization
Organization Name:CARL G PURVIS DPM PA
Other - Org Name:PURVIS FOOT & ANKLE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
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:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908144Medicaid
NC020NKOtherBCBS OF NC
NC394110OtherPHCS
6856119OtherUNITED HEALTH CARE
6856119OtherUNITED HEALTH CARE