Basic Information
| Provider Information | |||||||||
| NPI: | 1891101390 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | POTTSTOWN MEDICAL SPECIALISTS, INC. | ||||||||
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| OtherOrganizationName: | PMSI DIVISION OF CARDIAC ELECTROPHYSIOLOGY | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1591 MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | POTTSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194643224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103268005 | ||||||||
| FaxNumber: | 6103279629 | ||||||||
| Practice Location | |||||||||
| Address1: | 1610 MEDICAL DR | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | POTTSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194643292 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103274200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2014 | ||||||||
| LastUpdateDate: | 07/14/2016 | ||||||||
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| AuthorizedOfficialLastName: | ENOCHS | ||||||||
| AuthorizedOfficialFirstName: | SHANA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 6103274200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0001X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
No ID Information.