Provider Demographics
NPI:1104856095
Name:DESERT REGIONAL MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:DESERT REGIONAL MEDICAL CENTER, INC.
Other - Org Name:DESERT REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:FISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-323-6483
Mailing Address - Street 1:PO BOX 57154
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-7154
Mailing Address - Country:US
Mailing Address - Phone:760-323-6492
Mailing Address - Fax:760-864-9577
Practice Address - Street 1:1150 N INDIAN CANYON DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4872
Practice Address - Country:US
Practice Address - Phone:760-323-6511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05-0243282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC000103570Medicaid
CAHSC30091GMedicaid
896568230OtherAETNA US HEALTHCARE (NATI
ALDES0243NMedicaid
ZZZA3305ZOtherBS OF CALIFORNIA
4284OtherCOVENTRY HEALTH CARE KANS
CO55570879Medicaid
ID805640400Medicaid
CAHPC01520FMedicaid
CAHSC30243HMedicaid
CALTC55417FMedicaid
CAZZT30243HMedicaid
000427OtherHUMANA
FL909949200Medicaid
MA7202733Medicaid
CACGP155444Medicaid
CAZZT40243HMedicaid
DC000303600Medicaid
KY01241181Medicaid
FL909949200Medicaid