Provider Demographics
NPI:1376058743
Name:SPECIALIZED INPATIENT MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:SPECIALIZED INPATIENT MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SIMERVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-581-7123
Mailing Address - Street 1:5 POMONA CT
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-2986
Mailing Address - Country:US
Mailing Address - Phone:719-581-7123
Mailing Address - Fax:719-564-1041
Practice Address - Street 1:855 HUNTER DR
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1867
Practice Address - Country:US
Practice Address - Phone:719-581-7123
Practice Address - Fax:719-564-1041
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERNAL MEDICINE & PEDIATRIC ASSOCIATES, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44566207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty