Organization
PMSI DIVISION OF CARDIOLOGY
Active
Parent organization
POTTSTOWN MEDICAL SPECIALIST, INC.
Other names
Pottstown Medical Specialists Cardiology
Organization subpart
Yes
Provider details
NPI number
Legal business name
POTTSTOWN MEDICAL SPECIALIST, INC.
Authorized official
SHANA M ENOCHS (CREDENTIALING SPECIALIST)
(610) 327-4200
Entity
Organization
Contact information
Practice address
1591 MEDICAL DRIVE, POTTSTOWN, PA 19464
(610) 326-8005
(610) 718-0788
Mailing address
1591 MEDICAL DRIVE, POTTSTOWN, PA 19464
(610) 326-8005
(610) 718-0788
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
MD044234E
—
207RI0011X
Interventional Cardiology Physician
MD062953L
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0859976000
KEYSTONE HMO
—
01
—
919371
BLUE SHIELD ASSIGN. ACCT
PA
Enumeration date
03/19/2007
Last updated
07/14/2016
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