| Ham Lane Clinic | |
|
845 S Fairmont Ave Ste 8 Lodi CA 95240-5113 | |
| (209) 339-7625 | |
| Not Available |
| Full Name | Ham Lane Clinic |
|---|---|
| Speciality | Clinic/center |
| Location | 845 S Fairmont Ave Ste 8, Lodi, California |
| Authorized Official Name and Position | Jason Whitney (FINANCE OFFICER) |
| Authorized Official Contact | 2093397477 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ham Lane Clinic Po Box 884577 Los Angeles CA 90088-4577 Ph: (209) 334-3411 | Ham Lane Clinic 845 S Fairmont Ave Ste 8 Lodi CA 95240-5113 Ph: (209) 339-7625 |
| NPI Number | 1881603009 |
|---|---|
| Provider Enumeration Date | 08/05/2006 |
| Last Update Date | 01/06/2022 |
| Certification Date | 01/06/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881603009 | NPI | - | NPPES |
| ZZZ62129Z | Other | CA | BS PROVIDER GRP NUMBER |
| GR0086834 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 030000056 (California) | Primary |
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