Provider Demographics
NPI:1952407629
Name:PACIFIC AMERICAN MEDICAL SERVICE INC
Entity type:Organization
Organization Name:PACIFIC AMERICAN MEDICAL SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:858-622-0792
Mailing Address - Street 1:5288 EASTGATE MALL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2835
Mailing Address - Country:US
Mailing Address - Phone:858-622-0792
Mailing Address - Fax:858-866-0760
Practice Address - Street 1:5288 EASTGATE MALL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2835
Practice Address - Country:US
Practice Address - Phone:858-622-0792
Practice Address - Fax:858-866-0760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHF69929335V00000X
2471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Single Specialty
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG149BMedicare PIN
CATG149AMedicare PIN