Provider Demographics
NPI:1033250410
Name:DESERT MEDICAL STAFFING, LLC
Entity type:Organization
Organization Name:DESERT MEDICAL STAFFING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:HENACH
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-453-6092
Mailing Address - Street 1:101 CIVIC CENTER LN
Mailing Address - Street 2:RADIATION-ONCOLOGY BUILDING
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5607
Mailing Address - Country:US
Mailing Address - Phone:928-453-6092
Mailing Address - Fax:928-505-5719
Practice Address - Street 1:101 CIVIC CENTER LN
Practice Address - Street 2:RADIATION-ONCOLOGY BUILDING
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5607
Practice Address - Country:US
Practice Address - Phone:928-453-6092
Practice Address - Fax:928-505-5719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31667174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG03499Medicare UPIN