DIGNITY HEALTH MEDICAL FOUNDATION NPI 1861410581

NPI Information

NPI: 1861410581
Provider Name: DIGNITY HEALTH MEDICAL FOUNDATION

Doing Business As: DIGNITY HEALTH MEDICAL GROUP - STOCKTON, A SERVICE OF DIGNITY HEALTH M

Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

Address:
3132 W MARCH LN
SUITE 5
STOCKTON, CA
ZIP 95219
Phone: (209) 475-5500
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DIGNITY HEALTH MEDICAL FOUNDATION is a multi-specialty clinic center in Stockton, CA. DIGNITY HEALTH MEDICAL FOUNDATION NPI is 1861410581. The provider is registered as an organization entity type.
The provider Is Doing Business As Dignity Health Medical Group - Stockton, A Service Of Dignity Health M.

The provider's business location address is:

3132 W MARCH LN
SUITE 5
STOCKTON, CA
ZIP 95219-354
Phone: (209) 475-5500
Fax: (209) 475-5515

The provider's authorized official is Theresa M Hylen .
The authorized official title is Chief Financial Officer and has the following contact phone number (916) 851-2559.

The CLIA number assigned to this NPI record is 05D1055261 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 7/18/2006 and was last updated on 11/18/2020.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM1300X	Clinic/Center	Multi-Specialty			Yes

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 Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	ZZZ66457Z	OTHER	CALIFORNIA	BLUE SHIELD
2	GR0091671	MEDICAID	CALIFORNIA
3	371518341	OTHER		STOCKTON LOC - IRS SP TAX
4	7291	OTHER		STOCKTON LOC - HEALTHNET

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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