Healthcare Provider Details

I. General information

NPI: 1144225608
Provider Name (Legal Business Name): HOPE SQUARE SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39700 BOB HOPE DRIVE SUITE 301
RANCHO MIRAGE CA
92270-7129
US

IV. Provider business mailing address

39700 BOB HOPE DRIVE SUITE 301
RANCHO MIRAGE CA
92270-7129
US

V. Phone/Fax

Practice location:
  • Phone: 760-346-7696
  • Fax: 760-340-5156
Mailing address:
  • Phone: 760-346-7696
  • Fax: 760-340-5156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number250000515
License Number StateCA

VIII. Authorized Official

Name: MISS KATHERINE L. REED
Title or Position: OFFICER, MEDICARE AUTHORIZED OFFICI
Credential:
Phone: 972-763-3859