Provider Demographics
NPI:1104206556
Name:PACIFIC HEALTHCARE GROUP
Entity Type:Organization
Organization Name:PACIFIC HEALTHCARE GROUP
Other - Org Name:RAINIER SURGICAL INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PUANANI
Authorized Official - Middle Name:
Authorized Official - Last Name:TAGOAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-486-0523
Mailing Address - Street 1:4150 B PL NW
Mailing Address - Street 2:STE 101
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001-2449
Mailing Address - Country:US
Mailing Address - Phone:253-486-0500
Mailing Address - Fax:
Practice Address - Street 1:4150 B PL NW
Practice Address - Street 2:STE 101
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-2449
Practice Address - Country:US
Practice Address - Phone:253-486-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies