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General NPI Number Information
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NPI Number | 1912995630
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Entity Type | Organization
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Legal Business Name | PURCELL CLINIC, PA
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Dates
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Enumeration Date | 10/06/2005
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Last Update Date | 07/22/2013
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Provider Practice Location Address
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Address Line | 418 S KING ST
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City | LAURINBURG
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State | NC
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Zip | 28352-3704
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Country | US
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Telephone | 910-276-7570
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Fax | 910-276-1327
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Provider Business Mailing Address
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Address Line | 418 S KING ST
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City | LAURINBURG
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State | NC
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Zip | 28352-3704
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Country | US
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Telephone | 910-276-7570
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Fax | 910-276-1327
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | SUSAN C WALSH
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Credential |
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Telephone | 910-276-7570
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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 | 21820
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License Number State | NC
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