Provider Demographics
NPI:1336445204
Name:PCM VENTURES
Entity Type:Organization
Organization Name:PCM VENTURES
Other - Org Name:VASCULAR SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CARLO
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:215-558-9190
Mailing Address - Street 1:5005 DUVAL ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-2538
Mailing Address - Country:US
Mailing Address - Phone:215-558-9190
Mailing Address - Fax:215-914-6356
Practice Address - Street 1:1088 W BALTIMORE PIKE
Practice Address - Street 2:HCII STE. 2500
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5146
Practice Address - Country:US
Practice Address - Phone:215-558-9190
Practice Address - Fax:215-914-6356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-09
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007398L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA228753Medicare UPIN