Provider Demographics
NPI:1114364866
Name:EISENHOWER MEDICAL CENTER
Entity Type:Organization
Organization Name:EISENHOWER MEDICAL CENTER
Other - Org Name:EISENHOWER
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:AUBREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SERFLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-340-3911
Mailing Address - Street 1:39000 BOB HOPE DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3221
Mailing Address - Country:US
Mailing Address - Phone:760-340-3911
Mailing Address - Fax:760-773-1239
Practice Address - Street 1:57725 29 PALMS HWY
Practice Address - Street 2:STE 201
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-3044
Practice Address - Country:US
Practice Address - Phone:760-346-7655
Practice Address - Fax:760-346-7651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-03
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology