Basic Information
| Provider Information | |||||||||
| NPI: | 1407885882 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PURVIS | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 37087 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212973087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286876282 | ||||||||
| FaxNumber: | 8286876285 | ||||||||
| Practice Location | |||||||||
| Address1: | 438 E VANN RD | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | GREENEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377437202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232781649 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 07/10/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | OS9714 | FL | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0114X | 654 | NE | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | 207X00000X | 2206 | TN | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 4282077 | 01 | TN | BCBST | OTHER | 1521019 | 05 | TN | MEDICAID | P00420317 | 01 | FL | RAILROAD MEDICARE | OTHER | 1811917628 | 01 | FL | MEDICARE GRP NPI # | OTHER | K4964 | 01 | FL | MEDICARE GRP # | OTHER |