Organization
PACIFIC MEDICAL, INC.
Active
Other names
Pacific Medical Prosthetics & Orthotics
Organization subpart
No
Provider details
NPI number
Authorized official
MARK WEAVER JD (GENERAL COUNSEL)
(800) 726-9180
Entity
Organization
Contact information
Practice address
1301 SECRET RAVINE PKWY, SUITE 100, ROSEVILLE, CA 95661-3096
(916) 788-0530
(916) 788-0553
Mailing address
FILE 1616, 1801 W OLYMPIC BLVD, PASADENA, CA 91199-1616
(800) 726-9180
(800) 861-5950
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0695470001
MEDICARE PROVIDER NUMBER
—
Enumeration date
08/12/2009
Last updated
02/04/2015
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