NPIMap

Organization Active NPI

Lodi Memorial Hospital Association Inc

Doing business as Lodi Memorial Pediatric Clinic

  • Clinic/Center
  • Lodi, CA
National Provider Identifier
1386654077
Registry record updated Jan 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
030000056 Issued in CA
Legal business name
LODI MEMORIAL HOSPITAL ASSOCIATION INC
Doing business as
Lodi Memorial Pediatric Clinic
Practice address
2415 W Vine St Ste 100
Lodi, CA 95242-3731
Phone
(209) 333-3135
Fax
(209) 339-7659
NPI assigned
Aug 8, 2006
Last updated
Jan 6, 2022By 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 Jan 6, 2022

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

Authorized official

Name
Jason Whitney
Title
Finance Officer
Phone
(209) 339-7477

Specialties & licenses 1

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

Addresses

Primary practice location

2415 W Vine St Ste 100
Lodi, CA 95242-3731

Mailing address

PO Box 884577
Los Angeles, CA 90088-4577
Phone (209) 334-3411

Other identifiers 2

IdentifierTypeStateIssuer
ZZZ02721ZOtherCABLUE SHIELD PROV GRP
GR0086831MedicaidCA

Other names 1

  • Lodi Memorial Pediatric Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lodi Memorial Hosptial Pharmacy West9 organizations share this tax ID, including this one
Part of
Lodi Memorial Hosptial Pharmacy West

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

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": "1641427200000",
    "number": "1386654077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 884577",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900884577",
            "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": "2415 W VINE ST STE 100",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952423731",
            "telephone_number": "209-333-3135",
            "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": "2022-01-06",
        "certification_date": "2022-01-06",
        "status": "A",
        "authorized_official_last_name": "WHITNEY",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "FINANCE OFFICER",
        "authorized_official_telephone_number": "209-339-7477"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "030000056",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROV GRP",
            "identifier": "ZZZ02721Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0086831",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lodi Memorial Pediatric Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lodi Memorial Pediatric 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 Jan 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.