MEDICARE: HEART GROUP OF THE EASTERN SHORE, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	25610	AL
2	261Q00000X	Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	DE4413	OTHER	AL	RR MEDICARE FOR GROUP
11	K814	OTHER	AL	MEDICARE GRP
13	51541652	OTHER	AL	MEDICARE BRAND
14	P00082012	OTHER	AL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1609095157	OTHER	AL	GRP NPI
4	51503479	OTHER	AL	BC/MC
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	1467430777	OTHER	AL	NPI
10	1689678674	OTHER	AL	BRAND NPI
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
15	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609095157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEART GROUP OF THE EASTERN SHORE, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 850266
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36685-0266
Country	:	US
Telephone Number	:	251-990-1920
Fax Number	:	251-990-1921

Provider Business Practice Location Address
First Line	:	150 S. INGLESIDE STREET
Second Line	:	#4 MEDICAL PARK
City	:	FAIRHOPE
State	:	AL
Zip	:	36532-1804
Country	:	US
Telephone Number	:	251-990-1920
Fax Number	:	251-990-1921

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. MICHAEL S PURSLEY
Credential	:	MD
Telephone Number	:	251-990-1920

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	12/09/2013

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Directions to “HEART GROUP OF THE EASTERN SHORE, P.C. ” Practice Location

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