Healthcare Provider Details

I. General information

NPI: 1801487491
Provider Name (Legal Business Name): PURPLE SHIELD MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3649 POST RD STE 2
WARWICK RI
02886-7236
US

IV. Provider business mailing address

3649 POST RD STE 2
WARWICK RI
02886-7236
US

V. Phone/Fax

Practice location:
  • Phone: 508-536-2730
  • Fax: 508-675-9920
Mailing address:
  • Phone: 508-536-2730
  • Fax: 508-675-9920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. JOSEPH MOSS
Title or Position: PRESIDENT
Credential:
Phone: 508-728-4178