Basic Information
Provider Information
NPI: 1861643991
EntityType: 2
ReplacementNPI:  
OrganizationName: EISENHOWER MEDICAL CENTER
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: EISENHOWER
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 39000 BOB HOPE DR
Address2:  
City: RANCHO MIRAGE
State: CA
PostalCode: 922703221
CountryCode: US
TelephoneNumber: 7603403911
FaxNumber: 7606743629
Practice Location
Address1: 78822 HIGHWAY 111
Address2:  
City: LA QUINTA
State: CA
PostalCode: 922532046
CountryCode: US
TelephoneNumber: 7605647000
FaxNumber: 7605640101
Other Information
ProviderEnumerationDate: 10/07/2008
LastUpdateDate: 02/10/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: SERFLING
AuthorizedOfficialFirstName: G.
AuthorizedOfficialMiddleName: AUBREY
AuthorizedOfficialTitleorPosition: CHIEF EXECUTIVE OFFICER
AuthorizedOfficialTelephone: 7603403911
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: EISENHOWER MEDICAL CENTER
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
282N00000X250000142CAN HospitalsGeneral Acute Care Hospital 
261QU0200X250000142CAY Ambulatory Health Care FacilitiesClinic/CenterUrgent Care

No ID Information.


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