Organization
CHISHOLM BRUCE B MC ASC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRUCE B CHISHOLM MD (CEO)
(760) 779-9559
Entity
Organization
Contact information
Practice address
39300 BOB HOPE DR, BANNAN BLDG 1208, RANCHO MIRAGE, CA 92270-3203
(760) 779-9559
(760) 779-5077
Mailing address
39300 BOB HOPE DR, BANNAN BLDG 1208, RANCHO MIRAGE, CA 92270-3203
(760) 779-9559
(760) 779-5077
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
G81937
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10005
IMQ ASC ACCREDITATION
CA
Enumeration date
05/23/2007
Last updated
08/22/2020
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