Provider Demographics
NPI:1609967645
Name:DESERT ROSE MANAGEMENT CORP
Entity Type:Organization
Organization Name:DESERT ROSE MANAGEMENT CORP
Other - Org Name:DESERT ROSE IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:ASHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-587-1818
Mailing Address - Street 1:5800 NW PRAIRIE VIEW RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2764
Mailing Address - Country:US
Mailing Address - Phone:816-587-1818
Mailing Address - Fax:816-505-5004
Practice Address - Street 1:1708 SYCAMORE AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-0927
Practice Address - Country:US
Practice Address - Phone:928-681-3600
Practice Address - Fax:928-681-3612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC 3365261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ763707Medicaid
AZAZ0728540OtherBCBS
AZ763707OtherAHCCCS
AZ763707Medicaid