Provider Type Icon

SUTTER GOULD MEDICAL FOUNDATION NPI 1063468106


NPI Information

NPI: 1063468106
Provider Name: SUTTER GOULD MEDICAL FOUNDATION

Doing Business As: LODI AVE CARE CENTER

Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 05D1050001

Address:
1300 W LODI AVE
STE P
LODI, CA
ZIP 95242
Phone: (209) 366-1990
Get Directions

SUTTER GOULD MEDICAL FOUNDATION is a family medicine in Lodi, CA. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. SUTTER GOULD MEDICAL FOUNDATION NPI is 1063468106. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Lodi Ave Care Center.

The provider's business location address is:

1300 W LODI AVE
STE P
LODI, CA
ZIP 95242-000
Phone: (209) 366-1990

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 CLIA number assigned to this NPI record is 05D1050001 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 5/26/2006 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
1208000000XPediatricsNo
2207Q00000XFamily 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
20586060019MEDICARE 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: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.