Provider Demographics
NPI:1154757698
Name:DESERT MEDICAL GROUP, INC
Entity type:Organization
Organization Name:DESERT MEDICAL GROUP, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP NETWORK ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:HELENE
Authorized Official - Middle Name:
Authorized Official - Last Name:LECLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-323-8657
Mailing Address - Street 1:275 N EL CIELO RD
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-6972
Mailing Address - Country:US
Mailing Address - Phone:760-323-8657
Mailing Address - Fax:760-318-9083
Practice Address - Street 1:72605 HIGHWAY 111
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-3392
Practice Address - Country:US
Practice Address - Phone:760-323-8657
Practice Address - Fax:760-318-9083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ94367ZMedicare PIN