Provider Demographics
NPI:1265423891
Name:DESERT POSITRON IMAGING CENTER, LLC
Entity type:Organization
Organization Name:DESERT POSITRON IMAGING CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-912-1878
Mailing Address - Street 1:74785 US HIGHWAY 111
Mailing Address - Street 2:SUITE 101
Mailing Address - City:INDIAN WELLS
Mailing Address - State:CA
Mailing Address - Zip Code:92210-7128
Mailing Address - Country:US
Mailing Address - Phone:760-346-4329
Mailing Address - Fax:760-346-4172
Practice Address - Street 1:74785 US HIGHWAY 111
Practice Address - Street 2:SUITE 101
Practice Address - City:INDIAN WELLS
Practice Address - State:CA
Practice Address - Zip Code:92210-7128
Practice Address - Country:US
Practice Address - Phone:760-346-4329
Practice Address - Fax:760-346-4172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CI1872OtherRAILROAD MEDICARE
ZZZ01127ZOtherBLUE SHIELD
ZZZ01127ZOtherBLUE SHIELD