Provider Demographics
NPI:1265439996
Name:DESERT DIALYSIS SERVICES, INC.
Entity type:Organization
Organization Name:DESERT DIALYSIS SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:PAIRSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-583-3131
Mailing Address - Street 1:13000 N 103RD AVE
Mailing Address - Street 2:STE. 66
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3024
Mailing Address - Country:US
Mailing Address - Phone:623-583-3131
Mailing Address - Fax:623-583-5414
Practice Address - Street 1:13000 N 103RD AVE
Practice Address - Street 2:STE. 66
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3024
Practice Address - Country:US
Practice Address - Phone:623-583-3131
Practice Address - Fax:623-583-5414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19729207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ394651Medicaid
AZ394651Medicaid
AZE79185Medicare UPIN