DIGNITY HEALTH MEDICAL GROUP - STOCKTON, A SERVICE OF DIGNITY HEALTH M
NPI 1609020569
Clinic/Center - Multi-Specialty in Stockton, CA
- Organization
- Clinic/Center
- Multi-Specialty
- CLIA Number: 05D2008727
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 06-15-2026
About DIGNITY HEALTH MEDICAL GROUP - STOCKTON, A SERVICE OF DIGNITY HEALTH M
This page provides the complete NPI Profile along with additional information for Dignity Health Medical Group - Stockton, A Service Of Dignity Health M, a provider established in Stockton, California operating as a Clinic/center, focusing in multi-specialty . The healthcare provider is registered in the NPI registry with number 1609020569 assigned on November 2008. The practitioner's primary taxonomy code is 261QM1300X. The provider is registered as an organization and their NPI record was last updated 6 years ago. The provider's is doing business as Dignity Health Medical Group - Stockton, A Service Of Dignity Health M. The authorized official of this NPI record is Theresa M Hylen (Chief Financial Officer)
- NPI
- 1609020569 Verify this NPI
- Provider Legal Name
- DIGNITY HEALTH MEDICAL FOUNDATION
- Other Organization Name
- DIGNITY HEALTH MEDICAL GROUP - STOCKTON, A SERVICE OF DIGNITY HEALTH M
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 534 E PINE ST SUITE B STOCKTON, CA 95204
- Location Phone
- (209) 466-1980
- Location Fax
- (209) 466-1982
- Mailing Address
- 3000 Q ST SACRAMENTO, CA 95816
- Mailing Phone
- (916) 733-5701
- Mailing Fax
- (916) 859-1671
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- Yes
- Enumeration Date
- 11-05-2008
- Last Update Date
- 11-18-2020
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Multi-Specialty
- Taxonomy Code
- 261QM1300X
- Type
- Ambulatory Health Care Facilities
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 05D2008727
- Facility Type
- Physician Office
- Certificate Effective Date
- June 16, 2024
- Certificate Expiration Date
- June 15, 2026
- Laboratory Director
- RICK L. RAWSON
- Certificate Type
- Certificate for Provider-Performed Microscopy Procedures (PPMP)
- Certificate Type Description
- This CLIA certificate is issued to Dignity Health Medical Group - Stockton, A Service Of Dignity Health M in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing.
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Other Providers at the Same Location
The following 14 providers are registered at the same or a nearby location.
STOCKTON, CA 95204
STOCKTON, CA 95204
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1609020569, enumerated as an "organization" on November 05, 2008.
The provider is located at 534 E PINE ST SUITE B STOCKTON, CA 95204 and the phone number is (209) 466-1980.
Clinic/Center with taxonomy code 261QM1300X and a focus in Multi-Specialty.
