FAIRMONT AVE CARE CENTER – NPI #1174570964
Internal Medicine

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Health Care Provider Taxonomy Code for Internal Medicine

FAIRMONT AVE CARE CENTER is a provider located in LODI, CA. NPPES has assigned the NPI number 1174570964 to FAIRMONT AVE CARE CENTER on May 27, 2006. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “FAIRMONT AVE CARE CENTER” is a dba name, the actual legal business name for this organization is SUTTER GOULD MEDICAL FOUNDATION. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 207R00000X from the Health Care Provider Taxonomy code set, which is classified as Internal Medicine.

The NPI profile was previously updated about 16 years ago on May 06, 2010. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for FAIRMONT AVE CARE CENTER below.

NPI Profile for
SUTTER GOULD MEDICAL FOUNDATION

NPI Number
1174570964
Enumeration Date

(more than 20 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
SUTTER GOULD MEDICAL FOUNDATION
Doing Business As (dba): FAIRMONT AVE CARE CENTER
Primary location
999 S FAIRMONT AVE
#130/135
LODI, CA 95240-5100
Phone: (209) 366-2001 Fax:
Mailing address
600 COFFEE RD
MODESTO, CA 95355-4201
Phone: (209) 524-1211 Fax:
Organization Subpart
No
Authorized Official
STEVEN MITNICK
MEDICAL DIRECTOR
Phone: (209) 521-6097
Updated
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
207R00000X
- Internal Medicine (Primary)
207V00000X
- Obstetrics & Gynecology

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.