Provider Demographics
NPI:1275863169
Name:EISENHOWER MEDICAL CENTER
Entity Type:Organization
Organization Name:EISENHOWER MEDICAL CENTER
Other - Org Name:EISENHOWER DESERT ORTHOPEDIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:CHS
Authorized Official - Phone:760-837-8691
Mailing Address - Street 1:39000 BOB HOPE DR
Mailing Address - Street 2:HARRY AND DIANE RINKER BUILDING
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:760-837-8327
Practice Address - Street 1:39000 BOB HOPE DR
Practice Address - Street 2:HARRY AND 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:760-340-3911
Practice Address - Fax:760-837-8327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250000142282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
050573Medicare UPIN