Provider Demographics
NPI:1114661253
Name:PACIFIC MEDICAL, INC.
Entity Type:Organization
Organization Name:PACIFIC MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL/C.L.O.
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-723-9180
Mailing Address - Street 1:1700 N CHRISMAN RD
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95304-9314
Mailing Address - Country:US
Mailing Address - Phone:800-726-9180
Mailing Address - Fax:
Practice Address - Street 1:275 SW 160TH ST STE 110
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3003
Practice Address - Country:US
Practice Address - Phone:206-241-2786
Practice Address - Fax:206-241-3349
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PACIFIC MEDICAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies