Provider Demographics
NPI:1821356742
Name:PREMIER SURGICAL ASSOC PALM SPRINGS INC
Entity Type:Organization
Organization Name:PREMIER SURGICAL ASSOC PALM SPRINGS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-766-1222
Mailing Address - Street 1:1180 N INDIAN CANYON DR
Mailing Address - Street 2:SUITE 421
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4882
Mailing Address - Country:US
Mailing Address - Phone:760-424-8224
Mailing Address - Fax:760-424-8227
Practice Address - Street 1:1180 N INDIAN CANYON DR
Practice Address - Street 2:SUITE 421
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4882
Practice Address - Country:US
Practice Address - Phone:760-424-8224
Practice Address - Fax:760-424-8227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-28
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty