MEDICARE: DR. EDWIN M PURVIS M.D.

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	207RC0000X	Cardiovascular Disease Physician	14003	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164409710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWIN M PURVIS M.D.

Provider Business Mailing Address
First Line	:	1600 22ND AVE
Second Line	:	MEDICAL TOWERS III
City	:	MERIDIAN
State	:	MS
Zip	:	39301-3223
Country	:	US
Telephone Number	:	601-483-5322
Fax Number	:	601-581-2289

Provider Business Practice Location Address
First Line	:	1600 22ND AVE
Second Line	:	MEDICAL TOWERS III
City	:	MERIDIAN
State	:	MS
Zip	:	39301-3223
Country	:	US
Telephone Number	:	601-483-5322
Fax Number	:	601-581-2289

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2005
Last Update Date	:	06/02/2011

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