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General NPI Number Information
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NPI Number | 1255603874
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Entity Type | Organization
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Legal Business Name | ORCHARD MEDICAL CLINIC
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Dates
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Enumeration Date | 01/27/2012
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Last Update Date | 02/16/2012
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Provider Practice Location Address
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Address Line | 5320 ORCHARD ST W
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98467-3633
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Country | US
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Telephone | 253-474-7100
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Fax | 253-474-2677
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Provider Business Mailing Address
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Address Line | 7501 92ND AVENUE CT SW
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City | LAKEWOOD
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State | WA
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Zip | 98498-3973
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Country | US
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Telephone | 253-588-0058
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Fax | 253-589-4862
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Authorized Official
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Title or Position | OWNER
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Name | DR. GLENN A PACIO
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Credential | M.D.
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Telephone | 253-474-7100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | MD000380965
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License Number State | WA
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