=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316938301
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LODI MEMORIAL HOSPITAL ASSOCIATION INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2005
-----------------------------------------------------
Last Update Date | 07/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 975 S FAIRMONT AVE
-----------------------------------------------------
City | LODI
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95240-5118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-334-3411
-----------------------------------------------------
Fax | 209-339-7659
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 884577
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90088-4577
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-334-3411
-----------------------------------------------------
Fax | 209-339-7659
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FINANCE OFFICER
-----------------------------------------------------
Name | KATIE J DELMORE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 209-339-7560
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 030000056
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------