Provider Demographics
NPI:1629085543
Name:DESERT PROVIDERS LLC
Entity Type:Organization
Organization Name:DESERT PROVIDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-723-5144
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:COOLIDGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85128-0001
Mailing Address - Country:US
Mailing Address - Phone:800-723-5144
Mailing Address - Fax:520-723-5413
Practice Address - Street 1:170 S ARIZONA BLVD
Practice Address - Street 2:
Practice Address - City:COOLIDGE
Practice Address - State:AZ
Practice Address - Zip Code:85128-4725
Practice Address - Country:US
Practice Address - Phone:800-723-5144
Practice Address - Fax:520-723-5413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ557506Medicaid
AZ0278340OtherBC/BS
AZ557506Medicaid