Provider Demographics
NPI:1215970348
Name:PACIFIC ORTHOPAEDIC MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:PACIFIC ORTHOPAEDIC MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:P
Authorized Official - Last Name:DU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-656-1324
Mailing Address - Street 1:622 W DUARTE RD
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-9278
Mailing Address - Country:US
Mailing Address - Phone:626-821-0700
Mailing Address - Fax:626-821-4450
Practice Address - Street 1:622 W DUARTE RD
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-9278
Practice Address - Country:US
Practice Address - Phone:626-821-0700
Practice Address - Fax:626-821-4450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW7065BMedicare ID - Type UnspecifiedORTHOPAEDIC SURGERY