Provider Demographics
NPI:1770658973
Name:PACIFIC HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:PACIFIC HEALTH SERVICES, LLC
Other - Org Name:PREMIERE SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:PIERPOINT
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:205-907-9973
Mailing Address - Street 1:2051 OLD MONTGOMERY HWY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1677
Mailing Address - Country:US
Mailing Address - Phone:205-982-7878
Mailing Address - Fax:205-982-7848
Practice Address - Street 1:2051 OLD MONTGOMERY HWY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-1677
Practice Address - Country:US
Practice Address - Phone:205-982-7878
Practice Address - Fax:205-982-7848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALL095Medicare PIN