Provider Demographics
NPI:1154655520
Name:PACESETTERS MEDICAL EQUIPMENT
Entity Type:Organization
Organization Name:PACESETTERS MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:MBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-826-4554
Mailing Address - Street 1:823 W MAIN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-1155
Mailing Address - Country:US
Mailing Address - Phone:253-826-4554
Mailing Address - Fax:253-904-8299
Practice Address - Street 1:823 W MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-1155
Practice Address - Country:US
Practice Address - Phone:253-826-4554
Practice Address - Fax:253-904-8299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602501089332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9055781Medicaid