Healthcare Provider Details

I. General information

NPI: 1740580380
Provider Name (Legal Business Name): PACIFIC BIOMEDICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2010
Last Update Date: 10/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#12 PATNITOS LN, ASLITO
SAIPAN MP
96950-2478
US

IV. Provider business mailing address

P.O. BOX 502478
SAIPAN MP
96950-2478
US

V. Phone/Fax

Practice location:
  • Phone: 670-288-0566
  • Fax: 670-234-2618
Mailing address:
  • Phone: 670-288-0566
  • Fax: 670-234-2618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. ESTANISLAO K. BENAVENTE
Title or Position: PRESIDENT
Credential:
Phone: 670-288-0566