Healthcare Provider Details

I. General information

NPI: 1396409363
Provider Name (Legal Business Name): PUREHEALTH MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1723 W M 32 STE B
GAYLORD MI
49735-9544
US

IV. Provider business mailing address

1723 W M 32 STE B
GAYLORD MI
49735-9544
US

V. Phone/Fax

Practice location:
  • Phone: 248-238-3666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AUTUMN PEEBLES
Title or Position: LEAD CREDENTIALING SPECIALIST
Credential:
Phone: 810-230-0338