MEDICARE: HI-DESERT MEDICAL CENTER

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	261QR0200X	Radiology Clinic/Center	240000231	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ35026Z	OTHER	CA	BLUE SHIELD
2	FNP31524	OTHER	CA	MEDICAL BOARD FICTITIOUS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477683951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HI-DESERT MEDICAL CENTER

Provider Business Mailing Address
First Line	:	43500 RIDGE PARK DR
Second Line	:	#102
City	:	TEMECULA
State	:	CA
Zip	:	92590-3624
Country	:	US
Telephone Number	:	951-699-0303
Fax Number	:	951-699-0603

Provider Business Practice Location Address
First Line	:	6601 WHITE FEATHER RD
Second Line	:
City	:	JOSHUA TREE
State	:	CA
Zip	:	92252-6607
Country	:	US
Telephone Number	:	760-366-6355
Fax Number	:	760-366-6364

Authorized Official
Title or Position	:	CFO
Name	:	MR. THOMAS DUDA
Credential	:
Telephone Number	:	760-366-6421

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	06/25/2008

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Directions to “HI-DESERT MEDICAL CENTER ” Practice Location

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