Organization
LODI MEMORIAL HOSPITAL ASSOCIATION INC
Active
Parent organization
LODI MEMORIAL HOSPITAL ASSOCIATION INC
Other names
PrimeMed 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
305 PRESTON AVE, IONE, CA 95640
(209) 274-2183
(209) 339-7659
Mailing address
PO BOX 884577, LOS ANGELES, CA 90088-4577
(209) 334-3411
(209) 339-7482
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
030000056
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0086835
—
CA
01
—
ZZZ53493Z
BLUE SHIELD PROV GRP
CA
Enumeration date
08/09/2006
Last updated
01/06/2022
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