Provider Demographics
NPI:1386625465
Name:PACIFIC INFUSION CARE INC
Entity type:Organization
Organization Name:PACIFIC INFUSION CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:DURTSCHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-823-7413
Mailing Address - Street 1:11860 KEMPER RD
Mailing Address - Street 2:#4
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603
Mailing Address - Country:US
Mailing Address - Phone:530-823-7413
Mailing Address - Fax:530-823-6798
Practice Address - Street 1:11860 KEMPER RD
Practice Address - Street 2:# 4
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603
Practice Address - Country:US
Practice Address - Phone:530-823-7413
Practice Address - Fax:530-823-6798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
CAPHY46211333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY462110Medicaid
1171610001Medicare ID - Type Unspecified