Provider Demographics
NPI:1861649352
Name:LODI MEMORIAL HOSPITAL ASSOCIATION, INC
Entity Type:Organization
Organization Name:LODI MEMORIAL HOSPITAL ASSOCIATION, INC
Other - Org Name:LODI MEMORIAL COMMUNITY CLINIC - IRIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER & PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:HARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-334-3411
Mailing Address - Street 1:PO BOX 3004
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95241-1908
Mailing Address - Country:US
Mailing Address - Phone:209-334-3411
Mailing Address - Fax:209-339-7659
Practice Address - Street 1:801 S HAM LANE
Practice Address - Street 2:SUITE S
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-7501
Practice Address - Country:US
Practice Address - Phone:209-334-3411
Practice Address - Fax:209-339-7659
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LODI MEMORIAL HOSPITAL ASSOCIATION, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-26
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QP2300X
CA550000838261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care