Provider Demographics
NPI:1316489644
Name:DESERT PEAKS HEALTH CARE, LLC
Entity type:Organization
Organization Name:DESERT PEAKS HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:CARISSA
Authorized Official - Last Name:KILLINGBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-724-4032
Mailing Address - Street 1:1555 SW REINDEER AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-9449
Mailing Address - Country:US
Mailing Address - Phone:541-548-4088
Mailing Address - Fax:541-548-3732
Practice Address - Street 1:3818 SW 21ST PL
Practice Address - Street 2:SUITE 201
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-6801
Practice Address - Country:US
Practice Address - Phone:541-548-4088
Practice Address - Fax:541-548-3732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-17
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty