NPIMap

Organization Active NPI

Western Pacific Med/Corp

  • Methadone Clinic
  • Glendale, CA
National Provider Identifier
1720279441
Registry record updated Sep 5, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
Legal business name
WESTERN PACIFIC MED/CORP
Practice address
4632 San Fernando Rd
Glendale, CA 91204-1822
Phone
(818) 956-3737
Fax
(818) 543-6767
NPI assigned
Aug 7, 2007
Last updated
Sep 5, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Mark Hickman
Title
Ceo
Phone
(818) 956-3737

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Methadone Clinic 261QM2800X CA Primary

Addresses

Primary practice location

4632 San Fernando Rd
Glendale, CA 91204-1822

Mailing address

4632 San Fernando Rd
Glendale, CA 91204-1822
Phone (818) 956-3737

Other identifiers 10

IdentifierTypeStateIssuer
HDC70061FMedicaidCA
CMM70074FMedicaidCA
CMM70208FMedicaidCA
CMM70054FMedicaidCA
HDC70062FMedicaidCA
HDC70063FMedicaidCA
CMM70047FMedicaidCA
HDC70028FMedicaidCA
HDC70023FMedicaidCA
CMM70045FMedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
Western Pacific Med-Corp19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

Locations

4632 San Fernando Rd
Glendale, CA 91204

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1186444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188950400000",
    "number": "1720279441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4632 SAN FERNANDO RD",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912041822",
            "telephone_number": "818-956-3737",
            "fax_number": "818-543-6767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4632 SAN FERNANDO RD",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912041822",
            "telephone_number": "818-956-3737",
            "fax_number": "818-543-6767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN PACIFIC MED/CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-07",
        "last_updated": "2007-09-05",
        "status": "A",
        "authorized_official_last_name": "HICKMAN",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-956-3737",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HDC70061F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMM70074F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMM70208F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMM70054F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HDC70062F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HDC70063F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMM70047F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HDC70028F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HDC70023F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMM70045F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.