Provider Demographics
NPI:1346301835
Name:DESERT VIEW CLINIC INC
Entity Type:Organization
Organization Name:DESERT VIEW CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADM PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-875-1328
Mailing Address - Street 1:11361 N 99 AVE
Mailing Address - Street 2:101
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345
Mailing Address - Country:US
Mailing Address - Phone:623-875-1328
Mailing Address - Fax:623-875-4196
Practice Address - Street 1:11361 N 99 AVE
Practice Address - Street 2:101
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345
Practice Address - Country:US
Practice Address - Phone:623-875-1328
Practice Address - Fax:623-875-4196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1916207Q00000X
AZMT02472P225700000X
AZMT05297P225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E20610Medicare UPIN
AZ67881Medicare ID - Type Unspecified