Provider Demographics
NPI:1356599591
Name:PACIFIC MEDICAL, INC.
Entity type:Organization
Organization Name:PACIFIC MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL/C.O.O.
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-726-9180
Mailing Address - Street 1:FILE 1616
Mailing Address - Street 2:1801 W OLYMPIC BLVD
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91199-1616
Mailing Address - Country:US
Mailing Address - Phone:800-726-9180
Mailing Address - Fax:800-861-5950
Practice Address - Street 1:1335 COFFEE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3188
Practice Address - Country:US
Practice Address - Phone:209-524-3113
Practice Address - Fax:209-524-3254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-29
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0695470001Medicare PIN