Provider Demographics
NPI:1366228082
Name:PURPOSE MEDICAL OUTREACH
Entity type:Organization
Organization Name:PURPOSE MEDICAL OUTREACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTHCARE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:804-557-0814
Mailing Address - Street 1:9660 TUNSTALL RD
Mailing Address - Street 2:
Mailing Address - City:NEW KENT
Mailing Address - State:VA
Mailing Address - Zip Code:23124-2912
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9660 TUNSTALL RD
Practice Address - Street 2:
Practice Address - City:NEW KENT
Practice Address - State:VA
Practice Address - Zip Code:23124-2912
Practice Address - Country:US
Practice Address - Phone:804-557-0814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW KENT CHRISTIAN CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty