Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 12/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S. INGLESIDE STREET #4 MEDICAL PARK
FAIRHOPE AL
36532-1804
US

IV. Provider business mailing address

PO BOX 850266
MOBILE AL
36685-0266
US

V. Phone/Fax

Practice location:
  • Phone: 251-990-1920
  • Fax: 251-990-1921
Mailing address:
  • Phone: 251-990-1920
  • Fax: 251-990-1921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number25610
License Number StateAL

VIII. Authorized Official

Name: DR. MICHAEL S PURSLEY
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 251-990-1920