MEDICARE: PURELY VASECTOMIES 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	208800000X	Urology Physician

General Provider Information

NPI Number	:	1629798251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURELY VASECTOMIES LLC

Provider Business Mailing Address
First Line	:	330 W MONTEBELLO AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-1847
Country	:	US
Telephone Number	:	602-799-2251
Fax Number	:

Provider Business Practice Location Address
First Line	:	14231 N 7TH ST STE 3A
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85022-4375
Country	:	US
Telephone Number	:	844-667-7376
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRENT LEE WOODMANSEE
Credential	:	DMD
Telephone Number	:	602-799-2251

Provider Enumeration Date	:	09/01/2022
Last Update Date	:	09/18/2025

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Directions to “PURELY VASECTOMIES LLC ” Practice Location

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