Basic Information
| Provider Information | |||||||||
| NPI: | 1114364866 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EISENHOWER MEDICAL CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | EISENHOWER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 39000 BOB HOPE DR | ||||||||
| Address2: | |||||||||
| City: | RANCHO MIRAGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922703221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603403911 | ||||||||
| FaxNumber: | 7607731239 | ||||||||
| Practice Location | |||||||||
| Address1: | 57725 29 PALMS HWY | ||||||||
| Address2: | STE 201 | ||||||||
| City: | YUCCA VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922843044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603467655 | ||||||||
| FaxNumber: | 7603467651 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2013 | ||||||||
| LastUpdateDate: | 10/16/2014 | ||||||||
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| AuthorizedOfficialLastName: | SERFLING | ||||||||
| AuthorizedOfficialFirstName: | AUBREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7603403911 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QX0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Oncology |
No ID Information.