| Desert Palms Medical Associates Inc | |
|
3015 Highway 95 Ste 105 Bullhead City AZ 86442-4334 | |
| (928) 763-2001 | |
| (928) 763-2038 |
| Full Name | Desert Palms Medical Associates Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3015 Highway 95 Ste 105, Bullhead City, Arizona |
| Authorized Official Name and Position | Heather Ann Brennan (ADMINISTRATOR) |
| Authorized Official Contact | 9287632001 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Desert Palms Medical Associates Inc 3015 Highway 95 Ste 105 Bullhead City AZ 86442-4334 Ph: (928) 763-2001 | Desert Palms Medical Associates Inc 3015 Highway 95 Ste 105 Bullhead City AZ 86442-4334 Ph: (928) 763-2001 |
| NPI Number | 1467509372 |
|---|---|
| Provider Enumeration Date | 01/04/2007 |
| Last Update Date | 06/30/2022 |
| Medicare PECOS PAC ID | 8820073133 |
|---|---|
| Medicare Enrollment ID | O20040621001904 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467509372 | NPI | - | NPPES |
| 323171 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 23472 (Arizona) | Primary |
| 261QU0200X | Clinic/center - Urgent Care | (* (Not Available)) | Secondary |
| Provider Name | Javed A Malik |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1487652350 PECOS PAC ID: 8729063557 Enrollment ID: I20040812000909 |
| Provider Name | Darren K Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205328382 PECOS PAC ID: 2062768948 Enrollment ID: I20180706002012 |
| Provider Name | Kristen N Peddycord |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144704933 PECOS PAC ID: 6002153640 Enrollment ID: I20190121001294 |
| Provider Name | Tiffany Lynn Doggett |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1447805080 PECOS PAC ID: 2961827662 Enrollment ID: I20200728003566 |
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