Provider Demographics
NPI:1609097740
Name:DESERT ISLAND SERVICES
Entity Type:Organization
Organization Name:DESERT ISLAND SERVICES
Other - Org Name:SOUTHWEST SURGICAL ASSISTING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRCHER-RAITT
Authorized Official - Suffix:
Authorized Official - Credentials:CST/CFA
Authorized Official - Phone:469-408-6197
Mailing Address - Street 1:3167 SAN MATEO #305
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-1921
Mailing Address - Country:US
Mailing Address - Phone:505-286-0654
Mailing Address - Fax:505-281-3022
Practice Address - Street 1:3167 SAN MATEO NE #305
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1921
Practice Address - Country:US
Practice Address - Phone:505-286-0654
Practice Address - Fax:505-281-3022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Multi-Specialty