Organization
PURCHASE CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES L WALLER JR. MD (MEDICAL DIRECTOR)
(270) 395-5388
Entity
Organization
Contact information
Practice address
503 5TH AVE, CALVERT CITY, KY 42029
(270) 395-5388
(270) 395-1792
Mailing address
PO BOX 1175, CALVERT CITY, KY 42029
(270) 395-5388
(270) 395-1792
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000174371
ANTHEM
—
05
—
65941718
—
KY
Enumeration date
12/11/2006
Last updated
02/08/2012
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