| Adventist Health Lodi Memorial | |
|
387 Civic Dr Galt CA 95632-2059 | |
| (209) 745-8080 | |
| (209) 745-8081 |
| Full Name | Adventist Health Lodi Memorial |
|---|---|
| Speciality | Clinic/Center |
| Location | 387 Civic Dr, Galt, California |
| Authorized Official Name and Position | Jason Whitney (FINANCE OFFICER) |
| Authorized Official Contact | 2093397477 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Adventist Health Lodi Memorial Po Box 884577 Los Angeles CA 90088-4577 Ph: (209) 334-3411 | Adventist Health Lodi Memorial 387 Civic Dr Galt CA 95632-2059 Ph: (209) 745-8080 |
| NPI Number | 1164431383 |
|---|---|
| Provider Enumeration Date | 08/05/2006 |
| Last Update Date | 04/01/2022 |
| Medicare PECOS PAC ID | 7618880717 |
|---|---|
| Medicare Enrollment ID | O20060426000877 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164431383 | NPI | - | NPPES |
| ZZZ53360Z | Other | CA | BLUE SHIELD PROV GRP |
| RHM18546F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | 030000056 (California) | Primary |
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