Provider Demographics
NPI:1598910853
Name:DESERT MEDICAL, LLC
Entity Type:Organization
Organization Name:DESERT MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EVERT
Authorized Official - Middle Name:ANDERS
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-294-4084
Mailing Address - Street 1:25 N 400 W
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-2778
Mailing Address - Country:US
Mailing Address - Phone:801-294-4084
Mailing Address - Fax:888-825-3019
Practice Address - Street 1:25 N 400 W
Practice Address - Street 2:SUITE 1
Practice Address - City:NORTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84054-2778
Practice Address - Country:US
Practice Address - Phone:801-294-4084
Practice Address - Fax:888-825-3019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-29
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies