Provider Demographics
NPI:1558576249
Name:DESERT ENDOVASCULAR CENTER, INC
Entity type:Organization
Organization Name:DESERT ENDOVASCULAR CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SITE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-833-1255
Mailing Address - Street 1:1450 S DOBSON RD
Mailing Address - Street 2:SUITE B120
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4712
Mailing Address - Country:US
Mailing Address - Phone:480-833-1255
Mailing Address - Fax:480-393-3395
Practice Address - Street 1:1450 S DOBSON RD
Practice Address - Street 2:SUITE B120
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4712
Practice Address - Country:US
Practice Address - Phone:480-833-1255
Practice Address - Fax:480-393-3395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty