Organization
LODI MEMORIAL HOSPITAL ASSOCIATION INC
Active
Parent organization
LODI MEMORIAL HOSPITAL ASSOCIATION INC
Other names
Lodi Memorial Primary Care Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
LODI MEMORIAL HOSPITAL ASSOCIATION INC
Authorized official
JASON WHITNEY (FINANCE OFFICER)
(209) 339-7477
Entity
Organization
Contact information
Practice address
2415 W VINE ST STE 105, LODI, CA 95242-3731
(209) 333-3121
(209) 339-7659
Mailing address
PO BOX 884577, LOS ANGELES, CA 90088-4577
(209) 334-3411
(209) 339-7659
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
030000056
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0086832
—
CA
01
—
ZZZ53358Z
BLUE SHIELD PROV GRP
CA
Enumeration date
08/05/2006
Last updated
01/06/2022
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