MEDICARE: CITY OF INDIO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	590003314	OTHER	CA	RRB

General Provider Information

NPI Number	:	1013913946
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF INDIO

Provider Business Mailing Address
First Line	:	PO BOX 2066
Second Line	:
City	:	INDIO
State	:	CA
Zip	:	92202-2066
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	46990 JACKSON ST
Second Line	:
City	:	INDIO
State	:	CA
Zip	:	92201-6042
Country	:	US
Telephone Number	:	760-347-0756
Fax Number	:

Authorized Official
Title or Position	:	ASST CITY MANAGER/FINANCE DIRECTOT
Name	:	ROBERT ROCKWELL
Credential	:
Telephone Number	:	760-391-4029

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	03/17/2018

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Directions to “CITY OF INDIO ” Practice Location

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