Basic Information
| Provider Information | |||||||||
| NPI: | 1093771073 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARTEL LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 884577 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900884577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093330905 | ||||||||
| FaxNumber: | 2093335243 | ||||||||
| Practice Location | |||||||||
| Address1: | 521 S HAM LN | ||||||||
| Address2: | SUITE F | ||||||||
| City: | LODI | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952423528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093330905 | ||||||||
| FaxNumber: | 2093330219 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 01/06/2022 | ||||||||
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| AuthorizedOfficialLastName: | WHITNEY | ||||||||
| AuthorizedOfficialFirstName: | JASON | ||||||||
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| AuthorizedOfficialTitleorPosition: | FINANCE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2093397477 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | LODI MEMORIAL HOSPITAL ASSOCIATION, INC. | ||||||||
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| NPICertificationDate: | 01/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 030000345 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | SUR01056G | 05 | CA | MEDICAID |