Provider Demographics
NPI:1780835819
Name:EISENHOWER MEDICAL CENTER
Entity type:Organization
Organization Name:EISENHOWER MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MASSIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-773-1228
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:760-773-1239
Practice Address - Street 1:72780 COUNTRY CLUB DR STE 205
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4150
Practice Address - Country:US
Practice Address - Phone:760-834-7900
Practice Address - Fax:760-834-7901
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EISENHOWER MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-07
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250000142261QP2300X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA050573Medicare Oscar/Certification