Provider Demographics
NPI:1538799234
Name:DESERT HEIGHTS FAMILY CLINIC PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:DESERT HEIGHTS FAMILY CLINIC PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FNP, CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LAMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:406-850-9247
Mailing Address - Street 1:PO BOX 4957
Mailing Address - Street 2:
Mailing Address - City:PAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:86040-4957
Mailing Address - Country:US
Mailing Address - Phone:928-612-3252
Mailing Address - Fax:928-415-4857
Practice Address - Street 1:665 S LAKE POWELL BLVD
Practice Address - Street 2:
Practice Address - City:PAGE
Practice Address - State:AZ
Practice Address - Zip Code:86040-0858
Practice Address - Country:US
Practice Address - Phone:928-612-3252
Practice Address - Fax:928-415-4857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-22
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical