1144225608 NPI number — HOPE SQUARE SURGICAL CENTER LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144225608 NPI number — HOPE SQUARE SURGICAL CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOPE SQUARE SURGICAL CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HOPE SQUARE SURGICAL CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144225608
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
39700 BOB HOPE DRIVE
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
RANCHO MIRAGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92270-7129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-346-7696
Provider Business Mailing Address Fax Number:
760-340-5156

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39700 BOB HOPE DRIVE
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
RANCHO MIRAGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92270-7129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-346-7696
Provider Business Practice Location Address Fax Number:
760-340-5156
Provider Enumeration Date:
06/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
REED
Authorized Official First Name:
KATHERINE
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
OFFICER, MEDICARE AUTHORIZED OFFICI
Authorized Official Telephone Number:
972-763-3859

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  250000515 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 051364 . This is a "BLUE CROSS OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com