Provider Demographics
NPI:1275076739
Name:DESERT SEDATION SERVICES LLC
Entity Type:Organization
Organization Name:DESERT SEDATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:B
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-318-2052
Mailing Address - Street 1:PO BOX 1209
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-2354
Mailing Address - Country:US
Mailing Address - Phone:928-318-2052
Mailing Address - Fax:928-318-2058
Practice Address - Street 1:2261 S AVENUE B
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6103
Practice Address - Country:US
Practice Address - Phone:928-318-2052
Practice Address - Fax:928-318-2058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty