| Lodi Memorial Hospital Association Inc | |
| 
					305 Preston Ave Ione CA 95640  | |
| (209) 274-2183 | |
| (209) 339-7659 | 
| Full Name | Lodi Memorial Hospital Association Inc | 
|---|---|
| Speciality | Clinic/center | 
| Location | 305 Preston Ave, Ione, 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 Hospital Association Inc Po Box 884577 Los Angeles CA 90088-4577 Ph: (209) 334-3411  | Lodi Memorial Hospital Association Inc 305 Preston Ave Ione CA 95640 Ph: (209) 274-2183  | 
| NPI Number | 1750391710 | 
|---|---|
| Provider Enumeration Date | 08/09/2006 | 
| Last Update Date | 01/06/2022 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1750391710 | NPI | - | NPPES | 
| GR0086835 | Medicaid | CA | |
| ZZZ53493Z | Other | CA | BLUE SHIELD PROV GRP | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 261Q00000X | Clinic/center | 030000056 (California) | Primary |