Healthcare Provider Details

I. General information

NPI: 1710001136
Provider Name (Legal Business Name): PMSI DIVISION OF CARDIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1591 MEDICAL DRIVE
POTTSTOWN PA
19464
US

IV. Provider business mailing address

1591 MEDICAL DRIVE
POTTSTOWN PA
19464
US

V. Phone/Fax

Practice location:
  • Phone: 610-326-8005
  • Fax: 610-718-0788
Mailing address:
  • Phone: 610-326-8005
  • Fax: 610-718-0788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD044234E
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD062953L
License Number State

VIII. Authorized Official

Name: SHANA M ENOCHS
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 610-327-4200