Provider Demographics
NPI:1205323805
Name:DESERTMED SUPPLY LLC
Entity type:Organization
Organization Name:DESERTMED SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOXLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-227-9143
Mailing Address - Street 1:1458 N HIGLEY RD STE 102
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-9601
Mailing Address - Country:US
Mailing Address - Phone:480-227-9143
Mailing Address - Fax:
Practice Address - Street 1:1458 N HIGLEY RD STE 102
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-1611
Practice Address - Country:US
Practice Address - Phone:801-510-8286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-18
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies