| Lodi Memorial Pediatric Clinic | |
|
2415 W Vine St Ste 100 Lodi CA 95242-3731 | |
| (209) 333-3135 | |
| (209) 339-7659 |
| Full Name | Lodi Memorial Pediatric Clinic |
|---|---|
| Speciality | Clinic/center |
| Location | 2415 W Vine St Ste 100, 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 |
|---|---|
| Lodi Memorial Pediatric Clinic Po Box 884577 Los Angeles CA 90088-4577 Ph: (209) 334-3411 | Lodi Memorial Pediatric Clinic 2415 W Vine St Ste 100 Lodi CA 95242-3731 Ph: (209) 333-3135 |
| NPI Number | 1386654077 |
|---|---|
| Provider Enumeration Date | 08/08/2006 |
| Last Update Date | 01/06/2022 |
| Certification Date | 01/06/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386654077 | NPI | - | NPPES |
| GR0086831 | Medicaid | CA | |
| ZZZ02721Z | Other | CA | BLUE SHIELD PROV GRP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 030000056 (California) | Primary |
Lodi Memorial Community Clinic-alder Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2407 W Vine St, Suite A, Lodi, CA 95242 Phone: 209-334-3411 Fax: 209-339-7659 |
Lodi Ave Care Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1300 W Lodi Ave, Ste P, Lodi, CA 95242 Phone: 209-366-1990 |
James S. Hoff, M.D., a Medical Corporation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 999 S Fairmont Ave, Suite 135, Lodi, CA 95240 Phone: 209-224-5719 Fax: 209-691-9521 |
Cmc, Lodi Vine Family Care, Suite 105 Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2415 W Vine St Ste 105, Lodi, CA 95242 Phone: 209-333-3121 |
Fairmont Ave Care Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 999 S Fairmont Ave, #130/135, Lodi, CA 95240 Phone: 209-366-2001 |
Lodi Memorial Urgent Care Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1235 W Vine St Ste 20, Lodi, CA 95240 Phone: 209-339-7625 Fax: 209-339-7659 |