Provider Demographics
NPI:1265664023
Name:PACIFIC MEDICAL, INC.
Entity Type:Organization
Organization Name:PACIFIC MEDICAL, INC.
Other - Org Name:PACIFIC MEDICAL PROSTHETICS & ORTHOTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:800-726-9180
Mailing Address - Street 1:FILE 1616
Mailing Address - Street 2:1801 W OLYMPIC BLVD
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91199-1616
Mailing Address - Country:US
Mailing Address - Phone:800-726-9180
Mailing Address - Fax:800-861-5950
Practice Address - Street 1:1301 SECRET RAVINE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3096
Practice Address - Country:US
Practice Address - Phone:916-788-0530
Practice Address - Fax:916-788-0553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-12
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0695470001OtherMEDICARE PROVIDER NUMBER
0695470006Medicare NSC