Provider Demographics
NPI:1114937554
Name:PACIFIC INTERNAL MEDICINE GROUP
Entity Type:Organization
Organization Name:PACIFIC INTERNAL MEDICINE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:562-426-6571
Mailing Address - Street 1:2777 PACIFIC AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2625
Mailing Address - Country:US
Mailing Address - Phone:562-426-6571
Mailing Address - Fax:562-595-8695
Practice Address - Street 1:2777 PACIFIC AVE
Practice Address - Street 2:SUITE E
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2625
Practice Address - Country:US
Practice Address - Phone:562-426-6571
Practice Address - Fax:562-595-8695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0026080Medicaid
CAGR0026080Medicaid