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NPI Code Detail

MEDICARE: DAMERON HOSPITAL ASSOCIATION

MEDICARE: DAMERON HOSPITAL ASSOCIATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1282N00000XGeneral Acute Care Hospital030000024CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538163886
Entity Type Code : Organization
Provider Name (Legal Business Name) : DAMERON HOSPITAL ASSOCIATION
Provider Business Mailing Address
First Line : 525 W ACACIA ST
Second Line :
City : STOCKTON
State : CA
Zip : 95203-2405
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 525 W ACACIA ST
Second Line :
City : STOCKTON
State : CA
Zip : 95203-2405
Country : US
Telephone Number : 209-944-5550
Fax Number :
Authorized Official
Title or Position : CONTROLLER
Name : MR. WILLIAM KENNETH CHASE
Credential :
Telephone Number : 209-461-3193
Provider Enumeration Date : 06/01/2005
Last Update Date : 08/21/2024

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Directions to “DAMERON HOSPITAL ASSOCIATION ” Practice Location

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