MEDICARE: RANCHO MIRAGE SURGICAL CENTER INC

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	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1477883981
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RANCHO MIRAGE SURGICAL CENTER INC

Provider Business Mailing Address
First Line	:	1199 N INDIAN CANYON DR
Second Line	:	A
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-4836
Country	:	US
Telephone Number	:	760-346-4334
Fax Number	:	760-346-3663

Provider Business Practice Location Address
First Line	:	1180 N PALM CANYON DR
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-4402
Country	:	US
Telephone Number	:	760-346-4334
Fax Number	:	760-346-3663

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. MAHER ALI ABDALLAH
Credential	:	M.D
Telephone Number	:	760-346-4334

Provider Enumeration Date	:	01/05/2010
Last Update Date	:	01/02/2013

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