Provider Demographics
NPI:1144225608
Name:HOPE SQUARE SURGICAL CENTER LLC
Entity Type:Organization
Organization Name:HOPE SQUARE SURGICAL CENTER LLC
Other - Org Name:HOPE SQUARE SURGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER, MEDICARE AUTHORIZED OFFICI
Authorized Official - Prefix:MISS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3859
Mailing Address - Street 1:39700 BOB HOPE DRIVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-7129
Mailing Address - Country:US
Mailing Address - Phone:760-346-7696
Mailing Address - Fax:760-340-5156
Practice Address - Street 1:39700 BOB HOPE DRIVE
Practice Address - Street 2:SUITE 301
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-7129
Practice Address - Country:US
Practice Address - Phone:760-346-7696
Practice Address - Fax:760-340-5156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250000515261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA051364OtherBLUE CROSS OF CALIFORNIA
CA051364OtherBLUE CROSS OF CALIFORNIA
ZZZ13607ZMedicare PIN