MEDICARE: MRS. DENISE DIANE PURDY

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1649458142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DENISE DIANE PURDY

Provider Business Mailing Address
First Line	:	3901 PARKRIDGE DR
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-0509
Country	:	US
Telephone Number	:	605-721-6732
Fax Number	:	605-721-6733

Provider Business Practice Location Address
First Line	:	3901 PARKRIDGE DR
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-0509
Country	:	US
Telephone Number	:	605-721-6732
Fax Number	:	605-721-6733

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

Provider Enumeration Date	:	02/06/2008
Last Update Date	:	02/06/2008

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Directions to “ MRS. DENISE DIANE PURDY ” Practice Location

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