Organization
ENDOSCOPY CENTER OF LODI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBIN KUEHNE RN BSN (DIRECTOR)
(209) 333-0905
Entity
Organization
Contact information
Practice address
840 S FAIRMONT AVE, SUITE 1, LODI, CA 95240-5105
(209) 371-8700
(209) 369-1262
Mailing address
840 S FAIRMONT AVE, SUITE 1, LODI, CA 95240-5105
(209) 371-8700
(209) 369-1262
Taxonomy
Speciality
Code
Description
License number
State
261QE0800X
Endoscopy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BQ951A
MEDICARE PTAN
—
Enumeration date
12/03/2008
Last updated
02/16/2018
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