MEDICARE: PACIFIC PHYSICIAN SERVICES, LLC

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	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861454449
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC PHYSICIAN SERVICES, LLC

Provider Business Mailing Address
First Line	:	500 PORTAGE LAKES DR
Second Line	:	STE. B
City	:	AKRON
State	:	OH
Zip	:	44319-2299
Country	:	US
Telephone Number	:	330-645-6934
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 PORTAGE LAKES DR
Second Line	:	STE. B
City	:	AKRON
State	:	OH
Zip	:	44319-2299
Country	:	US
Telephone Number	:	330-645-6934
Fax Number	:

Authorized Official
Title or Position	:	VP
Name	:	V. KAREN FLINN
Credential	:
Telephone Number	:	214-473-3994

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	08/22/2020

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Directions to “PACIFIC PHYSICIAN SERVICES, LLC ” Practice Location

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