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

General Provider Information

NPI Number	:	1912324633
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 BLD
City	:	PASADENA
State	:	CA
Zip	:	91199-1166
Country	:	US
Telephone Number	:	800-726-9180
Fax Number	:	800-861-5950

Provider Business Practice Location Address
First Line	:	1344 LIBERTY ST SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-4283
Country	:	US
Telephone Number	:	800-726-9180
Fax Number	:	800-861-5950

Authorized Official
Title or Position	:	GENERAL COUNSEL
Name	:	MARK WEAVER
Credential	:	JD
Telephone Number	:	800-726-9180

Provider Enumeration Date	:	03/19/2014
Last Update Date	:	03/19/2014

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