Basic Information
| Provider Information | |||||||||
| NPI: | 1881781482 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MENIFEE VALLEY MEDICAL CENTER | ||||||||
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| OtherOrganizationName: | A CALIFORNIA LOCAL HEALTHCARE DISTRICT | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1117 E DEVONSHIRE AVE | ||||||||
| Address2: | |||||||||
| City: | HEMET | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92543 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 28400 MCCALL BLVD | ||||||||
| Address2: | |||||||||
| City: | SUN CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92586 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516522811 | ||||||||
| FaxNumber: | 9519256323 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2006 | ||||||||
| LastUpdateDate: | 07/11/2008 | ||||||||
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| AuthorizedOfficialLastName: | GARKO | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO INTERIM CEO | ||||||||
| AuthorizedOfficialTelephone: | 9517666472 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CPA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 250000338 | CA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | HSP40684F | 01 | CA | MEDICAL | OTHER | ZZZC3300Z | 01 | CA | BLUE SHIELD | OTHER | HSC30684F | 01 | CA | MEDICAL | OTHER |