NPIMap

Organization Active NPI

Lodi Memorial Hospital Association Inc

Doing business as Lodi Memorial Urgent Care Clinic

  • Urgent Care Clinic/Center
  • Lodi, CA
National Provider Identifier
1194735886
Registry record updated Dec 21, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
License
030000056 Issued in CA
Legal business name
LODI MEMORIAL HOSPITAL ASSOCIATION INC
Doing business as
Lodi Memorial Urgent Care Clinic
Practice address
1235 W Vine St Ste 20
Lodi, CA 95240-5109
Phone
(209) 339-7625
Fax
(209) 339-7659
NPI assigned
Aug 8, 2006
Last updated
Dec 21, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
LODI MEMORIAL HOSPITAL ASSOCIATION INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 21, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Joseph P Harrington
Title
Ceo Chief Executive Officer
Phone
(209) 334-3411

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 030000056 CA
Urgent Care Clinic/Center 261QU0200X 030000056 CA Primary

Addresses

Primary practice location

1235 W Vine St Ste 20
Lodi, CA 95240-5109

Mailing address

PO Box 3004
Lodi, CA 95241-1908
Phone (209) 334-3411

Other identifiers 2

IdentifierTypeStateIssuer
ZZZ53356ZOtherCABLUE SHIELD PROV GRP
GR0086833MedicaidCA

Other names 1

  • Lodi Memorial Urgent Care Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050517000577 CA Part B Supplier - Clinic/Group Practice 7618880717 Receives reassigned benefits from 228 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lodi, CA

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Lodi Memorial Hosptial Pharmacy West

Locations

1235 W Vine St
Ste 20
Lodi, CA 95240
Phone (209) 339-7410

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292889600000",
    "number": "1194735886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3004",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952411908",
            "telephone_number": "209-334-3411",
            "fax_number": "209-339-7659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1235 W VINE ST STE 20",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952405109",
            "telephone_number": "209-339-7625",
            "fax_number": "209-339-7659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LODI MEMORIAL HOSPITAL ASSOCIATION INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LODI MEMORIAL HOSPITAL ASSOCIATION INC",
        "enumeration_date": "2006-08-08",
        "last_updated": "2010-12-21",
        "status": "A",
        "authorized_official_last_name": "HARRINGTON",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CEO CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "209-334-3411"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "030000056",
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "CA",
            "license": "030000056",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROV GRP",
            "identifier": "ZZZ53356Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0086833",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lodi Memorial Urgent Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lodi, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.