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SUTTER GOULD MEDICAL FOUNDATION NPI 1174570964


NPI Information

NPI: 1174570964
Provider Name: SUTTER GOULD MEDICAL FOUNDATION

Doing Business As: FAIRMONT AVE CARE CENTER

Classification: Internal Medicine - 207R00000X
Entity Type: Organization
Address:
999 S FAIRMONT AVE
#130/135
LODI, CA
ZIP 95240
Phone: (209) 366-2001
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SUTTER GOULD MEDICAL FOUNDATION is an internal medicine in Lodi, CA. The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. SUTTER GOULD MEDICAL FOUNDATION NPI is 1174570964. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Fairmont Ave Care Center.

The provider's business location address is:

999 S FAIRMONT AVE
#130/135
LODI, CA
ZIP 95240-100
Phone: (209) 366-2001

The provider's authorized official is Steven A Mitnick .
The authorized official title is Medical Director and has the following contact phone number (209) 521-6097.

The enumeration date for this NPI number is 5/27/2006 and was last updated on 5/6/2010.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207V00000XObstetrics & GynecologyNo
2207R00000XInternal MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1ZZZ20685ZMEDICARE ID-TYPE UNSPECIFIEDCALIFORNIAMEDICARE NUMBER
20586060021MEDICARE NSCCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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