Provider Demographics
NPI:1295755676
Name:PALM SPRINGS GENERAL HOSPITAL INC NEW CORPORATION
Entity type:Organization
Organization Name:PALM SPRINGS GENERAL HOSPITAL INC NEW CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-824-4703
Mailing Address - Street 1:1475 W 49TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3222
Mailing Address - Country:US
Mailing Address - Phone:305-558-2500
Mailing Address - Fax:305-826-9002
Practice Address - Street 1:1475 W 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3222
Practice Address - Country:US
Practice Address - Phone:305-558-2500
Practice Address - Fax:305-826-9002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RC0000X, 207ZC0006X
FL4065282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care HospitalGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0050OtherMEDICARE PART B
FL010053600Medicaid
FL100050Medicare ID - Type Unspecified