Provider Demographics
NPI:1013034776
Name:DESERT HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:DESERT HEALTHCARE SERVICES LLC
Other - Org Name:PRIMECARE CENTRAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MALLAPPA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEELAPPA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-345-6860
Mailing Address - Street 1:PO BOX 6229
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-2510
Mailing Address - Country:US
Mailing Address - Phone:928-345-6860
Mailing Address - Fax:
Practice Address - Street 1:284 W 32ND ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8152
Practice Address - Country:US
Practice Address - Phone:928-341-4563
Practice Address - Fax:928-344-2055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC 1175261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1176490001Medicare NSC
AZZWDBYNMedicare PIN