Basic Information
| Provider Information | |||||||||
| NPI: | 1710276225 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PSYCHIATRIC INPATIENT MANAGEMENT SERVICES, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7711 LOUIS PASTEUR DR | ||||||||
| Address2: | SUITE 708 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105758229 | ||||||||
| FaxNumber: | 2105754013 | ||||||||
| Practice Location | |||||||||
| Address1: | 8026 FLOYD CURL DR | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105758229 | ||||||||
| FaxNumber: | 2105754013 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2011 | ||||||||
| LastUpdateDate: | 07/27/2011 | ||||||||
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| AuthorizedOfficialLastName: | CLOUD | ||||||||
| AuthorizedOfficialFirstName: | ROBERTA | ||||||||
| AuthorizedOfficialMiddleName: | S. | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2105758501 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 0053WN | 01 | TX | BCBS | OTHER |