Provider Demographics
NPI:1629516620
Name:HT FAMILY PHYSICIANS
Entity Type:Organization
Organization Name:HT FAMILY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:M
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:209-477-5552
Mailing Address - Street 1:77 W MARCH LN
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5724
Mailing Address - Country:US
Mailing Address - Phone:209-477-5552
Mailing Address - Fax:209-477-5553
Practice Address - Street 1:999 S FAIRMONT AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-5100
Practice Address - Country:US
Practice Address - Phone:209-400-2040
Practice Address - Fax:209-400-2050
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HT FAMILY PHYSICIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-09
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty