Organization
PACIFICSOURCE PACE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTIN KERNUTT JD (CHIEF LEGAL COUNSEL)
(541) 225-1967
Entity
Organization
Contact information
Practice address
555 INTERNATIONAL WAY STE B104, SPRINGFIELD, OR 97477-6013
(458) 544-0400
Mailing address
555 INTERNATIONAL WAY STE B104, SPRINGFIELD, OR 97477-6013
(458) 544-0400
(541) 255-2797
Taxonomy
Speciality
Code
Description
License number
State
251T00000X
PACE Provider Organization
Primary
—
—
Other
Enumeration date
11/21/2025
Last updated
07/16/2026
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