1487645933 NPI number — DESERT MEDICAL GROUP-DESERT SPECIALTY GROUP

Table of content: (NPI 1487645933)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487645933 NPI number — DESERT MEDICAL GROUP-DESERT SPECIALTY GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DESERT MEDICAL GROUP-DESERT SPECIALTY GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DESERT OASIS HEALTHCARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487645933
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
275 N EL CIELO RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALM SPRINGS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92262-6972
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-320-4122
Provider Business Mailing Address Fax Number:
760-320-2725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
69844 HIGHWAY 111
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RANCHO MIRAGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92270-2849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-318-4869
Provider Business Practice Location Address Fax Number:
760-320-2725
Provider Enumeration Date:
11/03/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LECLAIR
Authorized Official First Name:
HELENE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
760-320-4122

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213EP1101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)