| |
1235 W Vine St Ste 20 Lodi CA 95240-5109 | |
(209) 339-7625 | |
(209) 339-7659 |
Full Name | |
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Speciality | Clinic/center - Urgent Care |
Location | 1235 W Vine St Ste 20, Lodi, California |
Authorized Official Name and Position | Joseph P Harrington (CEO CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 2093343411 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 3004 Lodi CA 95241-1908 Ph: (209) 334-3411 | 1235 W Vine St Ste 20 Lodi CA 95240-5109 Ph: (209) 339-7625 |
NPI Number | 1194735886 |
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Provider Enumeration Date | 08/08/2006 |
Last Update Date | 12/21/2010 |
Identifier | Type | State | Issuer |
---|---|---|---|
1194735886 | NPI | - | NPPES |
GR0086833 | Medicaid | CA | |
ZZZ53356Z | Other | CA | BLUE SHIELD PROV GRP |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | 030000056 (California) | Secondary |
261QU0200X | Clinic/center - Urgent Care | 030000056 (California) | Primary |
Inpatient Services Of California, Inc., A Medical Corporation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 975 S. Fairmont Ave, Lodi, CA 95240 Phone: 214-712-2400 |