Provider Demographics
NPI:1376872978
Name:PACIFIC WEST SERVICES
Entity type:Organization
Organization Name:PACIFIC WEST SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM SERVICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:NABORS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-647-2859
Mailing Address - Street 1:16634 TRANQUIL DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-1983
Mailing Address - Country:US
Mailing Address - Phone:832-647-2859
Mailing Address - Fax:281-277-0411
Practice Address - Street 1:4434 BLUEBONNET DR STE 145
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-2904
Practice Address - Country:US
Practice Address - Phone:832-647-2859
Practice Address - Fax:281-277-0411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0311434302R00000X
305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicare PIN