Shock Thomas Gen Ptr

LBN: Lodi Podiatry Group
Shock Thomas Gen Ptr is an health care organization with primary practice located at 1300 W Lodi Ave Ste W, Lodi CA 95242-3038. The organization recently has 3 registered licenses in different health care specialties including Podiatric Medicine & Surgery Service Providers / Podiatrist, Podiatric Medicine & Surgery Service Providers / Radiology, Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery. Podiatric Medicine & Surgery Service Providers / Podiatrist is the primary health care specialty. Lodi Podiatry Group can be contacted via phone (209) 334-6664, or through Myers, Kerry Lyn via phone (209) 334-0429.

Contact Information

Primary practice address
1300 W Lodi Ave Ste W Lodi CA 95242-3038
Phone: (209) 334-6664
Fax: (209) 334-2379
Website:
Map and Directions
Authorized official contact:
Name: Myers, Kerry Lyn
Phone: (209) 334-0429

Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X E3241 California
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X E3467 California
Podiatric Medicine & Surgery Service Providers / Radiology 213ER0200X E3241 California
Podiatric Medicine & Surgery Service Providers / Radiology 213ER0200X E3467 California
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X E3241 California
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X E3467 California

Profile Details

NPI number 1750360699
LBN Legal business name Lodi Podiatry Group
DBA Doing business as Shock Thomas Gen Ptr
Authorized official Myers, Kerry Lyn
Entity Organization
Organization subpart 1 No
Enumeration date Jan 10th, 2006
Last updated Nov 12th, 2015 - about 10 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1750360699 NPPES
California MEDICAID 000E32410
California MEDICAID 000E34670

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