| |
78120 Wildcat Dr Palm Desert CA 92211-1140 | |
(760) 360-1433 | |
(760) 360-5092 |
Full Name | |
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Speciality | Family Medicine |
Location | 78120 Wildcat Dr, Palm Desert, California |
Authorized Official Name and Position | Stephen R Steele (PRESIDENT) |
Authorized Official Contact | 7603601433 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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78120 Wildcat Dr Palm Desert CA 92211-1140 Ph: (760) 360-1433 | 78120 Wildcat Dr Palm Desert CA 92211-1140 Ph: (760) 360-1433 |
NPI Number | 1902015498 |
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Provider Enumeration Date | 05/21/2007 |
Last Update Date | 11/20/2008 |
Medicare PECOS PAC ID | 4486741956 |
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Medicare Enrollment ID | O20071107000846 |
Identifier | Type | State | Issuer |
---|---|---|---|
1902015498 | NPI | - | NPPES |
1285632604 | Other | TYPE 1 NPI NUMBER | |
20A555 | Other | CA | LICENSE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207QS0010X | Family Medicine - Sports Medicine | 20A555 (California) | Primary |
Faculty Physicians And Surgeons Of Llusm Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 41865 Boardwalk, Suite 103, Palm Desert, CA 92211 Phone: 760-341-5570 Fax: 909-558-3905 | |
Jitka Civrna Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 74000 Country Club Dr Ste G2, Palm Desert, CA 92260 Phone: 760-773-4948 Fax: 760-773-4910 | |