Provider Demographics
NPI:1417978065
Name:LODI SICK ROOM SUPPLY INC
Entity Type:Organization
Organization Name:LODI SICK ROOM SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CANEPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-369-3641
Mailing Address - Street 1:340 S FAIRMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-3802
Mailing Address - Country:US
Mailing Address - Phone:209-369-3641
Mailing Address - Fax:209-369-4618
Practice Address - Street 1:340 S FAIRMONT AVE
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-3802
Practice Address - Country:US
Practice Address - Phone:209-369-3641
Practice Address - Fax:209-369-4618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAZZZ49755Z332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ49755ZMedicaid
CA0323660001Medicare ID - Type Unspecified