Provider Demographics
NPI:1316144090
Name:DESERT MEDICAL LLC
Entity type:Organization
Organization Name:DESERT MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEAUDOIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-495-3537
Mailing Address - Street 1:43491 N FRIEND AVE
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85242-9621
Mailing Address - Country:US
Mailing Address - Phone:480-987-4181
Mailing Address - Fax:800-681-0684
Practice Address - Street 1:43491 N FRIEND AVE
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85242-9621
Practice Address - Country:US
Practice Address - Phone:480-987-4181
Practice Address - Fax:800-681-0684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2007-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ20176791OtherSTATE RESALE TAX NUMBER