Provider Demographics
NPI:1144310723
Name:MEDICAL ASSOCIATES OF THE PACIFIC LLC
Entity type:Organization
Organization Name:MEDICAL ASSOCIATES OF THE PACIFIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:S
Authorized Official - Last Name:ADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:670-323-9000
Mailing Address - Street 1:PO BOX 500938
Mailing Address - Street 2:MARINA HEIGHTS BUSINESS PARK SUITE 100
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950-0938
Mailing Address - Country:US
Mailing Address - Phone:670-323-9000
Mailing Address - Fax:670-323-9010
Practice Address - Street 1:MARINA HEIGHTS BUSINESS PARK
Practice Address - Street 2:SUITE 100
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950-0938
Practice Address - Country:US
Practice Address - Phone:670-323-9000
Practice Address - Fax:670-323-9010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MP0220207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I25872Medicare UPIN
MPH100240Medicare PIN