=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831686591
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEMET VALLEY MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2018
-----------------------------------------------------
Last Update Date | 04/18/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1117 E DEVONSHIRE AVE
-----------------------------------------------------
City | HEMET
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92543-3083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-652-2811
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 535 E STATE ROUTE 133
-----------------------------------------------------
City | ARCOLA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61910-3793
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RESIDENT
-----------------------------------------------------
Name | DANIEL FISHEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 217-840-6401
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------