Provider Demographics
NPI:1407915911
Name:DESERT VIEW FAMILY MEDICAL CENTER
Entity Type:Organization
Organization Name:DESERT VIEW FAMILY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:STACEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-727-7800
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89041-0129
Mailing Address - Country:US
Mailing Address - Phone:775-727-7800
Mailing Address - Fax:775-727-7807
Practice Address - Street 1:1401 S HIGHWAY 160
Practice Address - Street 2:STE B
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-4784
Practice Address - Country:US
Practice Address - Phone:775-727-7800
Practice Address - Fax:775-727-7807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11436207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty