Desert Ridge Medical LLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

DESERT RIDGE MEDICAL LLC

Practice address

26224 N Tatum Blvd Ste 11
Phoenix, AZ 85050-7500

Phone

(480) 634-6400

Fax

(480) 404-9649

NPI assigned

Jan 30, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Challen Waychoff III

Title

Coo/Manager

Phone

(480) 634-6400

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1517270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517270400000",
    "number": "1265930614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3724 N 3RD ST STE 301",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122035",
            "telephone_number": "480-634-6400",
            "fax_number": "480-404-9649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26224 N TATUM BLVD STE 11",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850507500",
            "telephone_number": "480-634-6400",
            "fax_number": "480-404-9649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESERT RIDGE MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-30",
        "last_updated": "2018-01-30",
        "status": "A",
        "authorized_official_last_name": "WAYCHOFF",
        "authorized_official_first_name": "CHALLEN",
        "authorized_official_title_or_position": "COO/MANAGER",
        "authorized_official_telephone_number": "480-634-6400",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Desert Ridge Facility LLC
• Desert Ridge Gastroenterology
• Desert Ridge Implant & Oral Surgery PC
• Desert Ridge Medical Group
• Desert Ridge Medical Group Anesthesia LLC
• Desert Ridge Oral,Facial & Implant Surgery, PLLC
• Desert Ridge Outpatient Surgery LLC
• Desert Ridge Pain Facility
• Desert Ridge Pediatric Dentistry
• Desert Ridge Prosthodontics

• Physical Medicine & Rehabilitation Physician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Physical Medicine & Rehabilitation Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.