Basic Information
| Provider Information | |||||||||
| NPI: | 1407007537 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EISENHOWER MEDICAL CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | EISENHOWER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 39000 BOB HOPE DRIVE | ||||||||
| Address2: | |||||||||
| City: | RANCHO MIRAGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922703221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603403911 | ||||||||
| FaxNumber: | 7606743629 | ||||||||
| Practice Location | |||||||||
| Address1: | 67780 E PALM CANYON DRIVE | ||||||||
| Address2: | |||||||||
| City: | CATHEDRAL CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922345441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603281000 | ||||||||
| FaxNumber: | 7603289379 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2008 | ||||||||
| LastUpdateDate: | 11/15/2011 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SERFLING | ||||||||
| AuthorizedOfficialFirstName: | G | ||||||||
| AuthorizedOfficialMiddleName: | AUBREY | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7603403911 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | EISENHOWER MEDICAL CENTER | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | 250000142 | CA | N | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | 282N00000X | 250000142 | CA | Y | Hospitals | General Acute Care Hospital |
No ID Information.