Healthcare Provider Details

I. General information

NPI: 1205126794
Provider Name (Legal Business Name): PACIFIC MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2011
Last Update Date: 02/21/2023
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 SOUTH AVE W STE 202
MISSOULA MT
59804-5137
US

IV. Provider business mailing address

FILE 1616 1801 W OLYMPIC BLVD
PASADENA CA
91199-1616
US

V. Phone/Fax

Practice location:
  • Phone: 406-327-9200
  • Fax: 406-327-0653
Mailing address:
  • Phone: 800-726-9180
  • Fax: 800-861-5950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MARK L. WEAVER
Title or Position: GENERAL COUNSEL/C.O.O.
Credential:
Phone: 800-726-9180