Provider Demographics
NPI:1942582135
Name:PROFESSIONAL IMMUNIZATIONS & MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:PROFESSIONAL IMMUNIZATIONS & MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MASTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:303-741-3955
Mailing Address - Street 1:5933 E GEDDES CIR
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1516
Mailing Address - Country:US
Mailing Address - Phone:303-741-3955
Mailing Address - Fax:720-493-8437
Practice Address - Street 1:5933 E GEDDES CIR
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1516
Practice Address - Country:US
Practice Address - Phone:303-741-3955
Practice Address - Fax:720-493-8437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO59186163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty