MEDICARE: PACIFIC MEDICAL, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	335E00000X	Prosthetic/Orthotic Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326048893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC MEDICAL, INC.

Provider Business Mailing Address
First Line	:	FILE 1616
Second Line	:	1801 W OLYMPIC BLVD
City	:	PASADENA
State	:	CA
Zip	:	91199-1616
Country	:	US
Telephone Number	:	800-726-9180
Fax Number	:	800-861-5950

Provider Business Practice Location Address
First Line	:	1700 N. CHRISMAN ROAD
Second Line	:
City	:	TRACY
State	:	CA
Zip	:	95304-9314
Country	:	US
Telephone Number	:	800-726-9180
Fax Number	:	800-861-5950

Authorized Official
Title or Position	:	GENERAL COUNSEL/C.O.O.
Name	:	MARK LOUIS WEAVER
Credential	:	J.D.
Telephone Number	:	800-726-9180

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	08/09/2013

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Directions to “PACIFIC MEDICAL, INC. ” Practice Location

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