Provider Demographics
NPI:1215054309
Name:DESERT HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:DESERT HEALTHCARE SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:11279 S GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85367-5885
Practice Address - Country:US
Practice Address - Phone:928-345-6830
Practice Address - Fax:928-345-6837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZWDBYNMedicare PIN
AZ1176490002Medicare NSC