Basic Information
| Provider Information | |||||||||
| NPI: | 1295755676 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PALM SPRINGS GENERAL HOSPITAL INC NEW CORPORATION | ||||||||
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| OtherOrganizationName: | PALM SPRINGS GENERAL HOSPITAL, INC. | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1475 W 49TH ST | ||||||||
| Address2: | |||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330123222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055582500 | ||||||||
| FaxNumber: | 3058269002 | ||||||||
| Practice Location | |||||||||
| Address1: | 1475 W 49TH ST | ||||||||
| Address2: | |||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330123222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055582500 | ||||||||
| FaxNumber: | 3058269002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 11/21/2014 | ||||||||
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| AuthorizedOfficialLastName: | MILIAN | ||||||||
| AuthorizedOfficialFirstName: | TONY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3058244703 | ||||||||
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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 | 207RC0000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207ZC0006X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology | 282N00000X | 4065 | FL | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 0050 | 01 | FL | MEDICARE PART B | OTHER | 010053600 | 05 | FL | MEDICAID |