Healthcare Provider Details

I. General information

NPI: 1548911811
Provider Name (Legal Business Name): PACIFIC MEDICAL SPECIALTY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 W YOUNG ST
ELMA WA
98541-9090
US

IV. Provider business mailing address

1117 W YOUNG ST
ELMA WA
98541-9090
US

V. Phone/Fax

Practice location:
  • Phone: 253-844-4327
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STANLEY FLEMMING
Title or Position: CMO
Credential: MD
Phone: 253-564-6675