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General NPI Number Information
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NPI Number | 1568469997
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Entity Type | Organization
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Legal Business Name | SAN GORGONIO MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 06/30/2005
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Last Update Date | 11/13/2013
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Provider Practice Location Address
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Address Line | 600 N HIGHLAND SPRINGS AVE
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City | BANNING
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State | CA
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Zip | 92220-3046
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Country | US
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Telephone | 951-845-1121
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Fax | 951-769-0431
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Provider Business Mailing Address
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Address Line | 600 N HIGHLAND SPRINGS AVE
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City | BANNING
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State | CA
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Zip | 92220-3046
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Country | US
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Telephone | 951-845-1121
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Fax | 951-769-0431
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Authorized Official
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Title or Position | DIRECTOR PT. FIN. SVC.
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Name | MS. MAYDA L. BROWN
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Credential |
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Telephone | 951-769-2170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 250001199
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License Number State | CA
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