MEDICARE: PACIFIC IMAGING SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1679542245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC IMAGING SERVICES

Provider Business Mailing Address
First Line	:	PO BOX K
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95055-3737
Country	:	US
Telephone Number	:	408-423-8001
Fax Number	:	408-247-5319

Provider Business Practice Location Address
First Line	:	1010 CASS ST
Second Line	:
City	:	MONTEREY
State	:	CA
Zip	:	93940-4515
Country	:	US
Telephone Number	:	831-655-0500
Fax Number	:	831-644-7700

Authorized Official
Title or Position	:	ACCOUNTING SUPERVISOR
Name	:	MS. GINNY L. OLEVSON
Credential	:
Telephone Number	:	408-423-8001

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	10/25/2007

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Directions to “PACIFIC IMAGING SERVICES ” Practice Location

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