Provider Demographics
NPI:1609007863
Name:INTERNAL MEDICINE & PEDIATRIC ASSOCIATES, LTD
Entity Type:Organization
Organization Name:INTERNAL MEDICINE & PEDIATRIC ASSOCIATES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SIMERVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-296-5854
Mailing Address - Street 1:PO BOX 567
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81002-0567
Mailing Address - Country:US
Mailing Address - Phone:719-296-5854
Mailing Address - Fax:719-542-0746
Practice Address - Street 1:1008 MINNEQUA AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3733
Practice Address - Country:US
Practice Address - Phone:719-560-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44566282E00000X, 282N00000X, 282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No282E00000XHospitalsLong Term Care Hospital
No282NC2000XHospitalsGeneral Acute Care HospitalChildren