Healthcare Provider Details

I. General information

NPI: 1619154556
Provider Name (Legal Business Name): PACOT BUILDERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 BROOKESTONE DR
FOREST VA
24551
US

IV. Provider business mailing address

PO BOX 915
FOREST VA
24551
US

V. Phone/Fax

Practice location:
  • Phone: 434-385-0545
  • Fax: 434-385-4766
Mailing address:
  • Phone: 434-385-0545
  • Fax: 434-385-4766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name: MR. GEORGE NICHOLAS PACOT III
Title or Position: OWNER
Credential:
Phone: 434-444-3725