Provider Demographics
NPI:1942341557
Name:RICHARD PURCELL MD, LLC
Entity Type:Organization
Organization Name:RICHARD PURCELL MD, LLC
Other - Org Name:ADULT MEDICINE AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:PURCELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-882-0200
Mailing Address - Street 1:4350 S NATIONAL AVE
Mailing Address - Street 2:SUITE C-200
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-2607
Mailing Address - Country:US
Mailing Address - Phone:417-882-0200
Mailing Address - Fax:417-882-0285
Practice Address - Street 1:4350 S NATIONAL AVE
Practice Address - Street 2:SUITE C-200
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65810-2607
Practice Address - Country:US
Practice Address - Phone:417-882-0200
Practice Address - Fax:417-882-0285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3M73207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty