MEDICARE: PURE MED SPA HUNTERSVILLE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS0132X	Ophthalmologic Surgery Clinic/Center	2001-0037	NC

General Provider Information

NPI Number	:	1023445079
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURE MED SPA HUNTERSVILLE PLLC

Provider Business Mailing Address
First Line	:	10210 HICKORYWOOD HILL AVE
Second Line	:	SUITE 100
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-3332
Country	:	US
Telephone Number	:	704-450-7563
Fax Number	:	704-288-4202

Provider Business Practice Location Address
First Line	:	10210 HICKORYWOOD HILL AVE
Second Line	:	SUITE 100
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-3332
Country	:	US
Telephone Number	:	704-450-7563
Fax Number	:	704-288-4202

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. BRIGGS EDWARD COOK JR.
Credential	:	MD
Telephone Number	:	704-604-2950

Provider Enumeration Date	:	10/07/2013
Last Update Date	:	10/07/2013

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