Provider Demographics
NPI:1467506451
Name:HALO MEDICAL GROUP
Entity Type:Organization
Organization Name:HALO MEDICAL GROUP
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:PO BOX 841163
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-1163
Mailing Address - Country:US
Mailing Address - Phone:760-776-8989
Mailing Address - Fax:760-779-8073
Practice Address - Street 1:74785 US HIGHWAY 111
Practice Address - Street 2:SUITE 101
Practice Address - City:INDIAN WELLS
Practice Address - State:CA
Practice Address - Zip Code:92210-7128
Practice Address - Country:US
Practice Address - Phone:760-776-8989
Practice Address - Fax:760-501-0311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 207V00000X, 2085N0700X, 2085R0204X, 2085U0001X, 208800000X, 213E00000X
CAFNP254532085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ02402ZOtherBLUE SHIELD PIN
CAZZZ02402ZOtherBLUE CROSS
CAZZZ64094ZOtherBLUE SHIELD PIN
CAZZZ64094ZOtherBLUE CROSS
CAGR0083072Medicaid
CAGR0083073Medicaid
CACK9031OtherRAILROAD MEDICARE
CAZZZ57290ZOtherBLUE SHIELD PIN
CAZZZ05859ZOtherBLUE CROSS
CAZZZ57290ZOtherBLUE CROSS
CAGR0083070Medicaid
CAGR0083071Medicaid
CAZZZ05859ZOtherBLUE SHIELD PIN
CAGR0083072Medicaid
CAZZZ57290ZOtherBLUE CROSS
CAZZZ25359ZMedicare PIN