Healthcare Provider Details

I. General information

NPI: 1629384615
Provider Name (Legal Business Name): EISENHOWER MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67555 E PALM CANYON DR STE C113
CATHEDRAL CITY CA
92234-5412
US

IV. Provider business mailing address

39000 BOB HOPE DR
RANCHO MIRAGE CA
92270-3221
US

V. Phone/Fax

Practice location:
  • Phone: 760-773-4300
  • Fax: 760-773-4285
Mailing address:
  • Phone: 760-340-3911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SCOTT JAMES FITZGERALD
Title or Position: VICE PRESIDENT - EMA
Credential:
Phone: 760-773-1451