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Organization
INDIAN WELLS MEDICAL CENTER
Active
Organization
INDIAN WELLS MEDICAL CENTER
Active
Other names
SPENCER MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CORVIN KELLY D.C. (DIRECTOR/OFFICER)
(760) 568-4544
Entity
Organization
Contact information
Practice address
74976 US HIGHWAY 111, INDIAN WELLS, CA 92210-7117
(760) 568-4544
(760) 568-4555
Mailing address
74976 HIGHWAY 111, INDIAN WELLS, CA 92210
(760) 568-4544
(760) 568-4555
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
DC26074
CA
207Q00000X
Family Medicine Physician
Primary
A83821
CA
207R00000X
Internal Medicine Physician
C29564
CA
208D00000X
General Practice Physician
A28654
CA
225100000X
Physical Therapist
PT19355
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ13978Z
BLUE SHIELD TRI-CARE WEST
CA
01
—
ZZZ13979Z
BLUE SHIELD PROVIDER #
CA
Enumeration date
07/17/2006
Last updated
03/15/2008
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