MEDICARE: DENISE PURVIS BILLING SERVICES

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1174062996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENISE PURVIS BILLING SERVICES

Provider Business Mailing Address
First Line	:	106 JATA DR
Second Line	:
City	:	MONROE CENTER
State	:	IL
Zip	:	61052-9794
Country	:	US
Telephone Number	:	815-226-8146
Fax Number	:

Provider Business Practice Location Address
First Line	:	5301 E STATE ST STE 301
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-2399
Country	:	US
Telephone Number	:	815-226-8146
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DENISE PURVIS
Credential	:
Telephone Number	:	815-226-8146

Provider Enumeration Date	:	02/13/2017
Last Update Date	:	02/13/2017

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