Provider Demographics
NPI:1083614929
Name:DESERT MEDICAL IMAGING, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DESERT MEDICAL IMAGING, A MEDICAL CORPORATION
Other - Org Name:DESERT MEDICAL IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-776-8989
Mailing Address - Street 1:74785 US HIGHWAY 111
Mailing Address - Street 2:STE 101
Mailing Address - City:INDIAN WELLS
Mailing Address - State:CA
Mailing Address - Zip Code:92210-7128
Mailing Address - Country:US
Mailing Address - Phone:760-776-8989
Mailing Address - Fax:760-779-8073
Practice Address - Street 1:1133 N PALM CANYON DR
Practice Address - Street 2:STE B
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4401
Practice Address - Country:US
Practice Address - Phone:760-322-8883
Practice Address - Fax:760-325-2037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP254532085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0083071Medicaid
CAZZZ02402ZOtherBLUE CROSS GROUP NUMBER
CAZZZ25359ZMedicare PIN