Provider Demographics
NPI:1215109715
Name:SDMS, P.C.
Entity type:Organization
Organization Name:SDMS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISHNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PINNAMANENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-838-2277
Mailing Address - Street 1:1847 E SOUTHERN AVE
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5881
Mailing Address - Country:US
Mailing Address - Phone:480-838-2277
Mailing Address - Fax:480-838-3887
Practice Address - Street 1:1847 E SOUTHERN AVE
Practice Address - Street 2:SUITE # 1
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-5881
Practice Address - Country:US
Practice Address - Phone:480-838-2277
Practice Address - Fax:480-838-3887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14173207R00000X, 207RE0101X, 207U00000X
AZ14172208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ238198Medicaid
AZ240747Medicaid
AZ240747Medicaid
AZZMD14173Medicare PIN