Provider Demographics
NPI:1477584993
Name:JFK MEMORIAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:JFK MEMORIAL HOSPITAL, INC.
Other - Org Name:JOHN F. KENNEDY MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-755-8018
Mailing Address - Street 1:FILE 57546
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-0001
Mailing Address - Country:US
Mailing Address - Phone:619-680-4100
Mailing Address - Fax:760-775-8014
Practice Address - Street 1:47-111 MONROE STREET
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201
Practice Address - Country:US
Practice Address - Phone:760-347-6191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25-50000155282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
050534B000000OtherSECTION 1011
CAHSP40534IMedicaid
ZZZA3329ZOtherBS OF CALIFORNIA
0012460001OtherPACIFICARE OF WASHINGTON
611858910OtherAETNA US HEALTHCARE
000403OtherHUMANA
CAHSC30534IMedicaid
001246-0001OtherPACIFICARE OF ARIZONA
CAHSP40534IMedicaid