Provider Demographics
NPI:1922131655
Name:DESERT INTEGRATED MEDICINE, LLC
Entity Type:Organization
Organization Name:DESERT INTEGRATED MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MELDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-668-0222
Mailing Address - Street 1:520 ROSE LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85390-1447
Mailing Address - Country:US
Mailing Address - Phone:928-668-0222
Mailing Address - Fax:928-668-0223
Practice Address - Street 1:520 ROSE LN
Practice Address - Street 2:SUITE A
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-1447
Practice Address - Country:US
Practice Address - Phone:928-668-0222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7685207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty