MEDICARE: DESERT DIALYSIS SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	19729	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265439996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT DIALYSIS SERVICES, INC.

Provider Business Mailing Address
First Line	:	13000 N 103RD AVE
Second Line	:	STE. 66
City	:	SUN CITY
State	:	AZ
Zip	:	85351-3024
Country	:	US
Telephone Number	:	623-583-3131
Fax Number	:	623-583-5414

Provider Business Practice Location Address
First Line	:	13000 N 103RD AVE
Second Line	:	STE. 66
City	:	SUN CITY
State	:	AZ
Zip	:	85351-3024
Country	:	US
Telephone Number	:	623-583-3131
Fax Number	:	623-583-5414

Authorized Official
Title or Position	:	OWNER/MEDICAL DIRECTOR
Name	:	DR. MARIO PAIRSE
Credential	:	M.D.
Telephone Number	:	623-583-3131

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	08/22/2020

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Directions to “DESERT DIALYSIS SERVICES, INC. ” Practice Location

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