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General NPI Number Information
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NPI Number | 1396409363
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Entity Type | Organization
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Legal Business Name | PUREHEALTH MEDICAL INC
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Dates
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Enumeration Date | 10/26/2021
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Last Update Date | 03/04/2022
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Provider Practice Location Address
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Address Line | 1723 W M 32 STE B
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City | GAYLORD
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State | MI
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Zip | 49735-9544
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Country | US
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Telephone | 248-238-3666
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Fax |
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Provider Business Mailing Address
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Address Line | 1723 W M 32 STE B
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City | GAYLORD
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State | MI
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Zip | 49735-9544
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LEAD CREDENTIALING SPECIALIST
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Name | AUTUMN PEEBLES
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Credential |
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Telephone | 810-230-0338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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