Provider Demographics
NPI:1447448378
Name:MICHAEL B PURNELL M D INC
Entity type:Organization
Organization Name:MICHAEL B PURNELL M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:COLLETTE
Authorized Official - Middle Name:J
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:209-524-4438
Mailing Address - Street 1:1335 COFFEE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3192
Mailing Address - Country:US
Mailing Address - Phone:209-524-5977
Mailing Address - Fax:209-524-7395
Practice Address - Street 1:1335 COFFEE RD STE 100
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3192
Practice Address - Country:US
Practice Address - Phone:209-524-5977
Practice Address - Fax:209-524-7395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA454810174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A454810Medicaid
CAE30286Medicare UPIN
CA00A454810Medicare PIN