Provider Demographics
NPI:1801487491
Name:PURPLE SHIELD MEDICAL LLC
Entity type:Organization
Organization Name:PURPLE SHIELD MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-728-4178
Mailing Address - Street 1:3649 POST RD STE 2
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-7236
Mailing Address - Country:US
Mailing Address - Phone:508-536-2730
Mailing Address - Fax:508-675-9920
Practice Address - Street 1:3649 POST RD STE 2
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-7236
Practice Address - Country:US
Practice Address - Phone:508-536-2730
Practice Address - Fax:508-675-9920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty