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General NPI Number Information
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NPI Number | 1609095157
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Entity Type | Organization
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Legal Business Name | HEART GROUP OF THE EASTERN SHORE, P.C.
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 12/09/2013
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Provider Practice Location Address
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Address Line | 150 S. INGLESIDE STREET #4 MEDICAL PARK
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City | FAIRHOPE
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State | AL
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Zip | 36532-1804
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Country | US
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Telephone | 251-990-1920
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Fax | 251-990-1921
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Provider Business Mailing Address
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Address Line | PO BOX 850266
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City | MOBILE
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State | AL
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Zip | 36685-0266
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Country | US
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Telephone | 251-990-1920
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Fax | 251-990-1921
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. MICHAEL S PURSLEY
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Credential | MD
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Telephone | 251-990-1920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25610
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License Number State | AL
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Taxonomy #2
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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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