Healthcare Provider Details

I. General information

NPI: 1730510272
Provider Name (Legal Business Name): HIGH DESERT PROFESSIONAL HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2013
Last Update Date: 12/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 W 1060 N
HURRICANE UT
84737-1913
US

IV. Provider business mailing address

59 W 1060 N
HURRICANE UT
84737-1913
US

V. Phone/Fax

Practice location:
  • Phone: 435-862-6143
  • Fax: 435-635-4506
Mailing address:
  • Phone: 435-862-6143
  • Fax: 435-635-4506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK LOUIS PHILLIPS
Title or Position: PRESIDENT / CEO
Credential:
Phone: 435-862-6143