Provider Demographics
NPI:1134439300
Name:PROFESSIONAL INPATIENT MEDICAL SERVICES, LLC
Entity type:Organization
Organization Name:PROFESSIONAL INPATIENT MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SRINIVISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PAMULAPATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-695-2797
Mailing Address - Street 1:1604 E JUNIPER WAY
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-8670
Mailing Address - Country:US
Mailing Address - Phone:262-695-2797
Mailing Address - Fax:
Practice Address - Street 1:1604 E JUNIPER WAY
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-8670
Practice Address - Country:US
Practice Address - Phone:262-695-2797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty