Provider Demographics
NPI:1972829224
Name:PEDIATRIC INPATIENT SPECIALISTS PC
Entity Type:Organization
Organization Name:PEDIATRIC INPATIENT SPECIALISTS PC
Other - Org Name:PEDIATRIC INPATIENT SPECIALISTS PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HILLEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:JANAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-220-8232
Mailing Address - Street 1:3000 BROAD ST
Mailing Address - Street 2:SUITE B-217
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-6786
Mailing Address - Country:US
Mailing Address - Phone:805-547-1255
Mailing Address - Fax:805-547-1395
Practice Address - Street 1:1400 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5906
Practice Address - Country:US
Practice Address - Phone:805-739-3600
Practice Address - Fax:805-739-3075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-12
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA31084OtherCITY OF SANTA MARIA BUSINESS LICENSE
CA9908569OtherAETNA GROUP PIN NUMBER
CAC3158471OtherSTATE DEPT OF CORPORATIONS NUMBER
CADP569AMedicare PIN