Provider Demographics
NPI:1144641093
Name:PERFUSION.COM, INC
Entity type:Organization
Organization Name:PERFUSION.COM, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:V
Authorized Official - Last Name:LICH
Authorized Official - Suffix:
Authorized Official - Credentials:CCP
Authorized Official - Phone:888-499-5672
Mailing Address - Street 1:17080 SAFETY ST STE 109
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-7506
Mailing Address - Country:US
Mailing Address - Phone:888-499-5672
Mailing Address - Fax:888-501-0844
Practice Address - Street 1:17080 SAFETY ST STE 109
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-7506
Practice Address - Country:US
Practice Address - Phone:888-499-5672
Practice Address - Fax:888-501-0844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-19
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionistGroup - Single Specialty