Provider Demographics
NPI:1891101051
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 1:1700 NCHRISMAN RD
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95304-9314
Mailing Address - Country:US
Mailing Address - Phone:800-726-9180
Mailing Address - Fax:800-861-5950
Practice Address - Street 1:961 MATLEY LN
Practice Address - Street 2:STE 160
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-2188
Practice Address - Country:US
Practice Address - Phone:775-324-2394
Practice Address - Fax:775-324-2918
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PACIFIC MEDICAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-09
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier