Healthcare Provider Details

I. General information

NPI: 1861643991
Provider Name (Legal Business Name): EISENHOWER MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78822 HIGHWAY 111
LA QUINTA CA
92253-2046
US

IV. Provider business mailing address

39000 BOB HOPE DR
RANCHO MIRAGE CA
92270-3221
US

V. Phone/Fax

Practice location:
  • Phone: 760-564-7000
  • Fax: 760-564-0101
Mailing address:
  • Phone: 760-340-3911
  • Fax: 760-674-3629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number250000142
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number250000142
License Number StateCA

VIII. Authorized Official

Name: MR. G. AUBREY SERFLING
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 760-340-3911