Healthcare Provider Details

I. General information

NPI: 1760984132
Provider Name (Legal Business Name): PACIFIC MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 03/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 E 2ND AVE
SPOKANE WA
99202-6010
US

IV. Provider business mailing address

1700 N CHRISMAN RD
TRACY CA
95304-9314
US

V. Phone/Fax

Practice location:
  • Phone: 509-534-1742
  • Fax: 509-242-2034
Mailing address:
  • Phone: 800-726-9180
  • Fax: 209-221-6113

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 WEAVER
Title or Position: C.O.O.
Credential:
Phone: 800-723-9180