Provider Demographics
NPI:1275749749
Name:DESERT ORTHOPEDIC CENTER, A MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:DESERT ORTHOPEDIC CENTER, A MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOAG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-766-1246
Mailing Address - Street 1:PO BOX 1730
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-1058
Mailing Address - Country:US
Mailing Address - Phone:760-568-2684
Mailing Address - Fax:760-341-5832
Practice Address - Street 1:39000 BOB HOPE DR
Practice Address - Street 2:HARRY & DIANE RINKER BUILDING
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3221
Practice Address - Country:US
Practice Address - Phone:760-568-2684
Practice Address - Fax:760-341-5832
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DESERT ORTHOPEDIC CENTER, A MEDICAL GROUP INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-14
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX I.D. NO.
CA0566140001Medicare NSC