Healthcare Provider Details

I. General information

NPI: 1144641093
Provider Name (Legal Business Name): PERFUSION.COM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2013
Last Update Date: 05/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17080 SAFETY ST STE 109
FORT MYERS FL
33908-7506
US

IV. Provider business mailing address

17080 SAFETY ST STE 109
FORT MYERS FL
33908-7506
US

V. Phone/Fax

Practice location:
  • Phone: 888-499-5672
  • Fax: 888-501-0844
Mailing address:
  • Phone: 888-499-5672
  • Fax: 888-501-0844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number
License Number State

VIII. Authorized Official

Name: MR. BRYAN V LICH
Title or Position: PRESIDENT
Credential: CCP
Phone: 888-499-5672