MEDICARE: PURPOSEWORKS, LLC

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	302F00000X	Exclusive Provider Organization	L16000039692	FL

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	:	1487015947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURPOSEWORKS, LLC

Provider Business Mailing Address
First Line	:	11701 PALM LAKE DR
Second Line	:	APT 1610
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-0903
Country	:	US
Telephone Number	:	904-651-6533
Fax Number	:

Provider Business Practice Location Address
First Line	:	11701 PALM LAKE DR
Second Line	:	APT 1610
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-0903
Country	:	US
Telephone Number	:	904-651-6533
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MARSHIRAY GRIFFIN
Credential	:
Telephone Number	:	904-651-6533

Provider Enumeration Date	:	03/11/2016
Last Update Date	:	03/11/2016

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Directions to “PURPOSEWORKS, LLC ” Practice Location

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