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M A C T HEALTH BOARD INCORPORATED NPI 1467444364


NPI Information

NPI: 1467444364
Provider Name: M A C T HEALTH BOARD, INCORPORATED

Doing Business As: MACT MEDICAL SONORA

Classification: Clinic/Center - 261Q00000X
Entity Type: Organization

CLIA Number: 05D1084391

Address:
13975 MONO WAY
SUITE G, H & I
SONORA, CA
ZIP 95370
Phone: (209) 533-9600
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M A C T HEALTH BOARD, INCORPORATED is a clinic center in Sonora, CA. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). M A C T HEALTH BOARD, INCORPORATED NPI is 1467444364. The provider is registered as an organization entity type.
The provider Is Doing Business As Mact Medical Sonora.

The provider's business location address is:

13975 MONO WAY
SUITE G, H & I
SONORA, CA
ZIP 95370-824
Phone: (209) 533-9600
Fax: (209) 533-9608

The provider's authorized official is John Alexander .
The authorized official title is Executive Director and has the following contact phone number (209) 754-6258.

The CLIA number assigned to this NPI record is 05D1084391 - community clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/17/2005 and was last updated on 11/17/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QC1500XClinic/CenterCommunity Health030000704CALIFORNIANo
2261Q00000XClinic/Center030000704CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1THP70875FMEDICAIDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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