Healthcare Provider Details

I. General information

NPI: 1407915911
Provider Name (Legal Business Name): DESERT VIEW FAMILY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S HIGHWAY 160 STE B
PAHRUMP NV
89048-4784
US

IV. Provider business mailing address

PO BOX 129
PAHRUMP NV
89041-0129
US

V. Phone/Fax

Practice location:
  • Phone: 775-727-7800
  • Fax: 775-727-7807
Mailing address:
  • Phone: 775-727-7800
  • Fax: 775-727-7807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11436
License Number StateNV

VIII. Authorized Official

Name: DR. MICHELLE L STACEY
Title or Position: CEO
Credential: M.D.
Phone: 775-727-7800