Basic Information
| Provider Information | |||||||||
| NPI: | 1144225608 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOPE SQUARE SURGICAL CENTER LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HOPE SQUARE SURGICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 39700 BOB HOPE DRIVE | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | RANCHO MIRAGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922707129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603467696 | ||||||||
| FaxNumber: | 7603405156 | ||||||||
| Practice Location | |||||||||
| Address1: | 39700 BOB HOPE DRIVE | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | RANCHO MIRAGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922707129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603467696 | ||||||||
| FaxNumber: | 7603405156 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2005 | ||||||||
| LastUpdateDate: | 08/07/2013 | ||||||||
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| AuthorizedOfficialLastName: | REED | ||||||||
| AuthorizedOfficialFirstName: | KATHERINE | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICER, MEDICARE AUTHORIZED OFFICI | ||||||||
| AuthorizedOfficialTelephone: | 9727633859 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 250000515 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 051364 | 01 | CA | BLUE CROSS OF CALIFORNIA | OTHER |