Provider Demographics
NPI:1821283987
Name:PACIFIC RIM INTEGRATED MEDICAL GROUP INC
Entity Type:Organization
Organization Name:PACIFIC RIM INTEGRATED MEDICAL GROUP INC
Other - Org Name:AMITABHA MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:QUINCY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:707-542-4800
Mailing Address - Street 1:7064 CORLINE CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4528
Mailing Address - Country:US
Mailing Address - Phone:707-829-5900
Mailing Address - Fax:707-829-5282
Practice Address - Street 1:7064 CORLINE CT
Practice Address - Street 2:SUITE A
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4528
Practice Address - Country:US
Practice Address - Phone:707-829-5900
Practice Address - Fax:707-829-5282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5137207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ13019ZOtherPIN
020A51370Medicare PIN
E25223Medicare UPIN