Healthcare Provider Details

I. General information

NPI: 1821356742
Provider Name (Legal Business Name): PREMIER SURGICAL ASSOC PALM SPRINGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2012
Last Update Date: 03/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 N INDIAN CANYON DR SUITE 421
PALM SPRINGS CA
92262-4882
US

IV. Provider business mailing address

1180 N INDIAN CANYON DR SUITE 421
PALM SPRINGS CA
92262-4882
US

V. Phone/Fax

Practice location:
  • Phone: 760-424-8224
  • Fax: 760-424-8227
Mailing address:
  • Phone: 760-424-8224
  • Fax: 760-424-8227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID S JOHNSON
Title or Position: PRESIDENT
Credential: MD
Phone: 951-766-1222