Provider Demographics
NPI:1730510272
Name:HIGH DESERT PROFESSIONAL HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:HIGH DESERT PROFESSIONAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-862-6143
Mailing Address - Street 1:59 W 1060 N
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-1913
Mailing Address - Country:US
Mailing Address - Phone:435-862-6143
Mailing Address - Fax:435-635-4506
Practice Address - Street 1:59 W 1060 N
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737-1913
Practice Address - Country:US
Practice Address - Phone:435-862-6143
Practice Address - Fax:435-635-4506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty