Provider Demographics
NPI:1588100564
Name:DESERT WEST OBGYN
Entity type:Organization
Organization Name:DESERT WEST OBGYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-978-1500
Mailing Address - Street 1:5601 W EUGIE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1256
Mailing Address - Country:US
Mailing Address - Phone:602-978-1500
Mailing Address - Fax:602-978-8944
Practice Address - Street 1:5601 W EUGIE AVE STE 100
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1256
Practice Address - Country:US
Practice Address - Phone:602-978-1500
Practice Address - Fax:602-978-8944
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DESERT WEST OB/GYN LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ360480Medicaid
AZZWCKHBMedicare UPIN