Provider Demographics
NPI:1861643991
Name:EISENHOWER MEDICAL CENTER
Entity Type:Organization
Organization Name:EISENHOWER MEDICAL CENTER
Other - Org Name:EISENHOWER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:G.
Authorized Official - Middle Name:AUBREY
Authorized Official - Last Name:SERFLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-340-3911
Mailing Address - Street 1:39000 BOB HOPE DR
Mailing Address - Street 2:
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:760-674-3629
Practice Address - Street 1:78822 HIGHWAY 111
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2046
Practice Address - Country:US
Practice Address - Phone:760-564-7000
Practice Address - Fax:760-564-0101
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EISENHOWER MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-07
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250000142261QU0200X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA050573Medicare Oscar/Certification