Provider Demographics
NPI:1821108812
Name:SEIP ORTHOPEDIC SURGERY
Entity Type:Organization
Organization Name:SEIP ORTHOPEDIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SEIP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-365-2520
Mailing Address - Street 1:57402 29 PALMS HWY
Mailing Address - Street 2:STE 5
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-2950
Mailing Address - Country:US
Mailing Address - Phone:760-365-2520
Mailing Address - Fax:760-365-2524
Practice Address - Street 1:57402 29 PALMS HWY
Practice Address - Street 2:STE 5
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-2950
Practice Address - Country:US
Practice Address - Phone:760-365-2520
Practice Address - Fax:760-365-2524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86692207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A866920Medicaid
CAZZZ31539ZMedicare PIN
CA00A866920Medicaid
CA6239400001Medicare NSC