Provider Demographics
NPI:1083826184
Name:DESERT MEDICAL PROVIDERS INC
Entity Type:Organization
Organization Name:DESERT MEDICAL PROVIDERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-426-3888
Mailing Address - Street 1:10288 N BALTIMORE DR
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85222-7318
Mailing Address - Country:US
Mailing Address - Phone:520-426-3888
Mailing Address - Fax:520-426-1916
Practice Address - Street 1:10288 N BALTIMORE DR
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-7318
Practice Address - Country:US
Practice Address - Phone:520-426-3888
Practice Address - Fax:520-426-1916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ231811Medicaid
AZ231811Medicaid