MEDICARE: DESERT REGIONAL MEDICAL CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	315D00000X	Inpatient Hospice	250000139	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679508774
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT REGIONAL MEDICAL CENTER, INC.

Provider Business Mailing Address
First Line	:	PO BOX 57154
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90074-7154
Country	:	US
Telephone Number	:	760-323-6492
Fax Number	:	760-864-9577

Provider Business Practice Location Address
First Line	:	555 E. TACHEVAH
Second Line	:	3E-101
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-5749
Country	:	US
Telephone Number	:	760-323-6511
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	JIMMY FISH
Credential	:
Telephone Number	:	760-323-6483

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	05/03/2022

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