Provider Demographics
NPI:1649252719
Name:BERNARD R PACINI MD PC
Entity type:Organization
Organization Name:BERNARD R PACINI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:PACINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-243-2479
Mailing Address - Street 1:425 PATTERSON
Mailing Address - Street 2:SUITE 406
Mailing Address - City:GRAND JCT
Mailing Address - State:CO
Mailing Address - Zip Code:81506-1910
Mailing Address - Country:US
Mailing Address - Phone:970-243-2479
Mailing Address - Fax:970-243-2481
Practice Address - Street 1:425 PATTERSON
Practice Address - Street 2:SUITE 406
Practice Address - City:GRAND JCT
Practice Address - State:CO
Practice Address - Zip Code:81506-1910
Practice Address - Country:US
Practice Address - Phone:970-243-2479
Practice Address - Fax:970-243-2481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO22743207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01227438Medicaid
69761Medicare ID - Type Unspecified
CO01227438Medicaid