1861809378 NPI number — PACIFIC MEDICAL, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861809378 NPI number — PACIFIC MEDICAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACIFIC MEDICAL, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861809378
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1700 N CHRISMAN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRACY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95304-9314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-726-9180
Provider Business Mailing Address Fax Number:
800-861-5950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2201 BROADWAY
Provider Second Line Business Practice Location Address:
STE 328
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94612-3017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-726-9180
Provider Business Practice Location Address Fax Number:
510-444-4568
Provider Enumeration Date:
07/16/2014

Additional Information

Authorized Official

Authorized Official Last Name:
WEAVER
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
GENERAL COUNSEL
Authorized Official Telephone Number:
800-726-9180

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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