Organization
DIGNITY HEALTH
Active
Organization
DIGNITY HEALTH
Active
Parent organization
DIGNITY HEALTH
Other names
St. John's Hospital Outpatient Lab
Organization subpart
Yes
Provider details
NPI number
Legal business name
DIGNITY HEALTH
Authorized official
ROBERT WARDWELL (CHIEF FINANCIAL OFFICER)
(805) 225-6121
Entity
Organization
Contact information
Practice address
1600 N ROSE AVE, OXNARD, CA 93030-3722
(805) 988-7090
(805) 981-7399
Mailing address
2415 ANTONIO AVE, CAMARILLO, CA 93010-1459
(805) 988-7090
(805) 981-7399
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
CLF 1206
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
62660
AETNA
—
01
—
651191373930300000
WPS/TRICARE - GENERAL ACUTE
—
01
—
651191373930300002
WPS/TRICARE - REHAB
—
01
—
651191373E
HEALTH NET
—
05
—
ZZT40082G
—
CA
01
—
ZZZC5602Z
BSCA
—
Enumeration date
05/30/2008
Last updated
09/23/2013
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