Provider Demographics
NPI:1184107070
Name:PULSE, PA
Entity type:Organization
Organization Name:PULSE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BACKUS-WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-629-2111
Mailing Address - Street 1:3420 TAMIAMI TRL UNIT 2
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8126
Mailing Address - Country:US
Mailing Address - Phone:941-629-2111
Mailing Address - Fax:941-627-5377
Practice Address - Street 1:3420 TAMIAMI TRL UNIT 2
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8126
Practice Address - Country:US
Practice Address - Phone:941-629-2111
Practice Address - Fax:941-627-5377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107666207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty