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General NPI Number Information
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NPI Number | 1376058743
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Entity Type | Organization
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Legal Business Name | SPECIALIZED INPATIENT MEDICAL SERVICES, LLC
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Dates
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Enumeration Date | 12/07/2017
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Last Update Date | 12/07/2017
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Provider Practice Location Address
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Address Line | 855 HUNTER DR
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City | PUEBLO
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State | CO
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Zip | 81001-1867
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Country | US
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Telephone | 719-581-7123
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Fax | 719-564-1041
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Provider Business Mailing Address
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Address Line | 5 POMONA CT
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City | PUEBLO
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State | CO
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Zip | 81005-2986
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Country | US
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Telephone | 719-581-7123
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Fax | 719-564-1041
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVEN JAMES SIMERVILLE
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Credential | MD
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Telephone | 719-581-7123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 44566
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 44566
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License Number State | CO
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