| 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 |