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General NPI Number Information
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NPI Number | 1922465087
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Entity Type | Organization
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Legal Business Name | PACIFIC SURGICAL CORP.
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Dates
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Enumeration Date | 01/20/2016
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Last Update Date | 01/20/2016
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Provider Practice Location Address
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Address Line | 1110 W. KETTLEMAN LN. SUITE 21
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City | LODI
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State | CA
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Zip | 95240-6047
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Country | US
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Telephone | 209-329-6443
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Fax | 209-365-6383
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Provider Business Mailing Address
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Address Line | 1110 W. KETTLEMAN LN. SUITE 21
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City | LODI
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State | CA
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Zip | 95240-6047
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Country | US
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Telephone | 209-329-6443
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Fax | 209-365-6383
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Authorized Official
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Title or Position | CEO/PRINCIPLE OWNER
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Name | MR. BRIAN EUGENE WHATLEY
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Credential |
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Telephone | 916-548-1880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | KH102259891
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License Number State | CA
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