Provider Demographics
NPI:1073378238
Name:CS PACS 3 WEST, LLC
Entity Type:Organization
Organization Name:CS PACS 3 WEST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKERINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-500-1325
Mailing Address - Street 1:1643 NW 136TH AVENUE
Mailing Address - Street 2:BUILDING H, SUITE 100
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323
Mailing Address - Country:US
Mailing Address - Phone:865-500-1325
Mailing Address - Fax:
Practice Address - Street 1:1002 W FREMONT AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-3031
Practice Address - Country:US
Practice Address - Phone:408-739-2383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty