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General NPI Number Information
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NPI Number | 1285406249
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Entity Type | Organization
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Legal Business Name | PACIFIC MEDICAL DIALYSIS SERVICES
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Dates
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Enumeration Date | 10/24/2023
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Last Update Date | 07/07/2026
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Provider Practice Location Address
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Address Line | 917 PACIFIC AVE STE 600
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City | TACOMA
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State | WA
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Zip | 98402-4437
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Country | US
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Telephone | 253-310-2236
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Fax |
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Provider Business Mailing Address
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Address Line | 917 PACIFIC AVE STE 600
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City | TACOMA
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State | WA
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Zip | 98402-4437
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MD
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Name | CHARLES MINN
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Credential | MD
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Telephone | 855-621-8250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WD1100X
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Taxonomy Name | Peritoneal Dialysis Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163WH0500X
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Taxonomy Name | Hemodialysis Registered Nurse
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2472R0900X
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Taxonomy Name | Renal Dialysis Technician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 332BD1200X
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Taxonomy Name | Dialysis Equipment & Supplies (DME)
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License Number |
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License Number State |
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