Provider Demographics
NPI:1841200748
Name:DESERT PRIMARY CARE MEDICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:DESERT PRIMARY CARE MEDICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GRIMM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:760-322-5156
Mailing Address - Street 1:1492 N PALM CANYON DR
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4412
Mailing Address - Country:US
Mailing Address - Phone:760-322-5156
Mailing Address - Fax:760-322-4021
Practice Address - Street 1:1492 N PALM CANYON DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4412
Practice Address - Country:US
Practice Address - Phone:760-322-5156
Practice Address - Fax:760-322-4021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6067207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE55265Medicare UPIN
CAMMM00209MMedicare PIN