Provider Demographics
NPI:1083751143
Name:HEMET URO-ENDO SURGICENTER INC.
Entity Type:Organization
Organization Name:HEMET URO-ENDO SURGICENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:J
Authorized Official - Last Name:DRUET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-506-9536
Mailing Address - Street 1:162 N SANTA FE ST
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4451
Mailing Address - Country:US
Mailing Address - Phone:951-929-2800
Mailing Address - Fax:951-929-2303
Practice Address - Street 1:162 N SANTA FE ST
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4451
Practice Address - Country:US
Practice Address - Phone:951-929-2800
Practice Address - Fax:951-929-2303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250000271261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ23403ZMedicare ID - Type Unspecified