NPIMap

Organization Active NPI

Pure Health Therapy Services, LLC

  • Physical Therapy Clinic/Center
  • Madison, MS
National Provider Identifier
1235845561
Registry record updated Jan 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
PURE HEALTH THERAPY SERVICES, LLC
Practice address
7521 Old Canton Rd
Madison, MS 39110-8669
Phone
(601) 856-8041
NPI assigned
Jan 30, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Vince Cameron
Title
Coo
Phone
(228) 348-0694

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 225200000X
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

7521 Old Canton Rd
Madison, MS 39110-8669

Mailing address

5703 Gulf Tech Dr
Ocean Springs, MS 39564-8238
Phone (228) 875-5447

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230315002680 MS Part B Supplier - Physical/Occupational Therapy Group in Private Practice 3779957667 Receives reassigned benefits from 8 practitioners
Practice locations: Collins, MS; Madison, MS; Sumrall, MS

National Provider Directory

National Provider Directory

Locations

100 Covington Ridge Pl
Collins, MS 39428
Phone (601) 765-1100

7521 Old Canton Rd
Madison, MS 39110
Phone (601) 856-8041

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1675036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675123200000",
    "number": "1235845561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5703 GULF TECH DR",
            "city": "OCEAN SPRINGS",
            "state": "MS",
            "postal_code": "395648238",
            "telephone_number": "228-875-5447",
            "fax_number": "228-875-5448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7521 OLD CANTON RD",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391108669",
            "telephone_number": "601-856-8041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PURE HEALTH THERAPY SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-30",
        "last_updated": "2023-01-31",
        "certification_date": "2023-01-31",
        "status": "A",
        "authorized_official_last_name": "CAMERON",
        "authorized_official_first_name": "VINCE",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "228-348-0694"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.